Healthcare Provider Details

I. General information

NPI: 1336753763
Provider Name (Legal Business Name): LUCHENA BELIZAIRE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8610 ROOSEVELT AVE
JACKSON HEIGHTS NY
11372-7503
US

IV. Provider business mailing address

67 SUTTER AVE APT 3
BROOKLYN NY
11212-4768
US

V. Phone/Fax

Practice location:
  • Phone: 718-565-6880
  • Fax:
Mailing address:
  • Phone: 917-561-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: