Healthcare Provider Details

I. General information

NPI: 1790474260
Provider Name (Legal Business Name): JEAN LOUKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PL
BRONX NY
10461-2720
US

IV. Provider business mailing address

1250 WATERS PL
BRONX NY
10461-2720
US

V. Phone/Fax

Practice location:
  • Phone: 347-577-4431
  • Fax: 347-577-4451
Mailing address:
  • Phone: 347-577-4431
  • Fax: 347-577-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number344047
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: