Healthcare Provider Details

I. General information

NPI: 1568428977
Provider Name (Legal Business Name): JEFFREY V LUCIDO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 77TH STREET
BROOKLYN NY
11209
US

IV. Provider business mailing address

441 77TH STREET
BROOKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-3800
  • Fax: 718-745-8999
Mailing address:
  • Phone: 718-745-3800
  • Fax: 718-745-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: