Healthcare Provider Details

I. General information

NPI: 1851596803
Provider Name (Legal Business Name): LUKASZ MARCIN SKOMIAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PLACE VA NY HARBOR HEALTHCARE SYSTEM- BROOKLYN CAMPUS
BROOKLYN NY
11209
US

IV. Provider business mailing address

419 PUTNAM RD
UNION NJ
07083
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-3651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number054210-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number22DI02418800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: