MEDICARE: DR. LUCIAN IANCOVICI M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1730330135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCIAN IANCOVICI M.D.

Provider Business Mailing Address
First Line	:	62 W 62ND ST
Second Line	:	APT 6G
City	:	NEW YORK
State	:	NY
Zip	:	10023-7000
Country	:	US
Telephone Number	:	617-291-4566
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 W 62ND ST
Second Line	:	APT 6G
City	:	NEW YORK
State	:	NY
Zip	:	10023-7000
Country	:	US
Telephone Number	:	617-291-4566
Fax Number	:

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

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	10/02/2008

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