MEDICARE: JOHN E LUKASZEWICZ MD

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	207Q00000X	Family Medicine Physician	148311	NY

General Provider Information

NPI Number	:	1972582807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E LUKASZEWICZ MD

Provider Business Mailing Address
First Line	:	19 TOWNLINE RD
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-4026
Country	:	US
Telephone Number	:	315-439-2372
Fax Number	:	888-855-3127

Provider Business Practice Location Address
First Line	:	19 TOWNLINE RD
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-4026
Country	:	US
Telephone Number	:	315-439-2372
Fax Number	:	888-855-3127

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	06/25/2010

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