Provider Demographics
NPI:1497583553
Name:AVENUE U KINGS COUNTY MEDICAL PLLC
Entity type:Organization
Organization Name:AVENUE U KINGS COUNTY MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCHKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-934-9068
Mailing Address - Street 1:4209 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4209 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5121
Practice Address - Country:US
Practice Address - Phone:347-934-9068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty