Provider Demographics
NPI:1326205691
Name:LUCKHURST, JOHN M (MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:LUCKHURST
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 STATE ROUTE 26
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:249 GLENWOOD RD
Practice Address - Street 2:ARTICLE 16 CLINIC AUDIOLOGY
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-0000
Practice Address - Country:US
Practice Address - Phone:607-240-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000866-1231H00000X
PAAT005926231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist