Provider Demographics
NPI:1508800293
Name:LUCHS, JONATHAN S (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:LUCHS
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 1:224 7TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5774
Mailing Address - Country:US
Mailing Address - Phone:516-747-0161
Mailing Address - Fax:516-873-6548
Practice Address - Street 1:3220 DISCOVERY DR STE 100
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8609
Practice Address - Country:US
Practice Address - Phone:517-975-8930
Practice Address - Fax:517-337-4985
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2094832085B0100X, 2085R0202X
MI43010984012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02623536Medicaid
NYI01397Medicare UPIN
NY666T71Medicare PIN
NYP00158465Medicare PIN
NYJL0666T710Medicare PIN