Provider Demographics
NPI:1497758734
Name:LUCAS, TYLER S (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:S
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2552
Mailing Address - Country:US
Mailing Address - Phone:914-249-7000
Mailing Address - Fax:914-249-7032
Practice Address - Street 1:1421 3RD AVE
Practice Address - Street 2:PENTHOUSE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1802
Practice Address - Country:US
Practice Address - Phone:212-876-5400
Practice Address - Fax:212-828-2344
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183122174400000X
CT037168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG78532Medicare UPIN
NY79G893Medicare ID - Type Unspecified