Healthcare Provider Details

I. General information

NPI: 1730313685
Provider Name (Legal Business Name): DEBRA LYNN LUCZKIEWICZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 COMO PARK BLVD
CHEEKTOWAGA NY
14227-1416
US

IV. Provider business mailing address

225 COMO PARK BLVD
CHEEKTOWAGA NY
14227-1416
US

V. Phone/Fax

Practice location:
  • Phone: 716-601-3962
  • Fax: 716-686-8100
Mailing address:
  • Phone: 716-601-3962
  • Fax: 716-686-8100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number250336
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: