Healthcare Provider Details

I. General information

NPI: 1629161526
Provider Name (Legal Business Name): ARTHUR SAUL LUKOFF D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 LAKE DR
ELLENVILLE NY
12428-2309
US

IV. Provider business mailing address

11 LAKE DR
ELLENVILLE NY
12428-2309
US

V. Phone/Fax

Practice location:
  • Phone: 845-647-3060
  • Fax: 845-647-3060
Mailing address:
  • Phone: 845-647-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberNOO2613
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberNOO2613
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: