Healthcare Provider Details

I. General information

NPI: 1942790845
Provider Name (Legal Business Name): RAYMOND MESHREKEY LUKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432-1121
US

IV. Provider business mailing address

352 WOODBURY RD
WOODBURY NY
11797-1263
US

V. Phone/Fax

Practice location:
  • Phone: 818-577-5849
  • Fax:
Mailing address:
  • Phone: 818-577-5849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number328826
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: