Provider Demographics
NPI:1851791875
Name:KEILI-LUCY LUKBAN & ASSOCIATES INC.
Entity Type:Organization
Organization Name:KEILI-LUCY LUKBAN & ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:917-749-5334
Mailing Address - Street 1:1940 MAYFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4007
Mailing Address - Country:US
Mailing Address - Phone:917-749-5334
Mailing Address - Fax:
Practice Address - Street 1:1940 MAYFLOWER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:917-749-5334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY620400963252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency