Healthcare Provider Details

I. General information

NPI: 1396390092
Provider Name (Legal Business Name): ANDRIY LUKOMSKY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 FINN RD STE C
HENRIETTA NY
14467-9393
US

IV. Provider business mailing address

PO BOX 212
MENDON NY
14506-0212
US

V. Phone/Fax

Practice location:
  • Phone: 585-444-0040
  • Fax:
Mailing address:
  • Phone: 585-582-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: