Provider Demographics
NPI:1215115761
Name:LAURA LUKASZEK, O.D., LLC
Entity type:Organization
Organization Name:LAURA LUKASZEK, O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LUKASZEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-464-0123
Mailing Address - Street 1:369 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1170
Mailing Address - Country:US
Mailing Address - Phone:908-464-0123
Mailing Address - Fax:908-665-2936
Practice Address - Street 1:369 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1170
Practice Address - Country:US
Practice Address - Phone:908-464-0123
Practice Address - Fax:908-665-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00045400261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU67707Medicare UPIN