MEDICARE: MR. COREY AUSTIN LUCIUS FNP-BC

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	363LF0000X	Family Nurse Practitioner	344660	NY

General Provider Information

NPI Number	:	1558916825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COREY AUSTIN LUCIUS FNP-BC

Provider Business Mailing Address
First Line	:	2563 33RD ST APT 2F
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-1248
Country	:	US
Telephone Number	:	901-361-3086
Fax Number	:	959-207-4223

Provider Business Practice Location Address
First Line	:	2563 33RD ST APT 2F
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-1248
Country	:	US
Telephone Number	:	901-361-3086
Fax Number	:	959-207-4223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	12/30/2025

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