Provider Demographics
NPI:1528575479
Name:LUCEY, COREY EVERETT
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:EVERETT
Last Name:LUCEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:EVERETT
Other - Last Name:LUCEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC STUDENT
Mailing Address - Street 1:587 UNIVERSITY AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1411
Mailing Address - Country:US
Mailing Address - Phone:585-369-6202
Mailing Address - Fax:
Practice Address - Street 1:350 NEW CAMPUS DR
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2997
Practice Address - Country:US
Practice Address - Phone:585-395-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program