MEDICARE: AVENUE U KINGS COUNTY MEDICAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1497583553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVENUE U KINGS COUNTY MEDICAL PLLC

Provider Business Mailing Address
First Line	:	4209 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4209 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5121
Country	:	US
Telephone Number	:	347-934-9068
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	NATALIYA LUCHKO
Credential	:
Telephone Number	:	347-934-9068

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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