Provider Demographics
NPI:1194166371
Name:LUCHS, BROOKE L (BROOKE L LUCHS)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:L
Last Name:LUCHS
Suffix:
Gender:F
Credentials:BROOKE L LUCHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 FRANKEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4732
Mailing Address - Country:US
Mailing Address - Phone:516-445-2647
Mailing Address - Fax:
Practice Address - Street 1:254 FRANKEL BLVD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4732
Practice Address - Country:US
Practice Address - Phone:516-445-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY740166174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist