Provider Demographics
NPI:1568428977
Name:LUCIDO, JEFFREY V (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:V
Last Name:LUCIDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 77TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-745-3800
Mailing Address - Fax:718-745-8999
Practice Address - Street 1:441 77TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-745-3800
Practice Address - Fax:718-745-8999
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004115213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
113055137OtherAFTRA
113055137Other1199
P746188OtherOXFORD
000043663OtherGHI HMO
163636OtherELDERPLAN
259850201OtherHEALTHPLUS
030004115NY01OtherANTHEM
113055137OtherAPWU
1C5680OtherPHS
113055137OtherAETNA
113055137OtherUNITED
NY00968401Medicaid
113055137OtherAIM
113055137OtherALICARE
P43111OtherEMPIRE BC BS
0014397OtherGHI
259850201OtherHEALTHPLUS
NY00968401Medicaid
113055137OtherAFTRA
NY00968401Medicaid