Healthcare Provider Details

I. General information

NPI: 1295317139
Provider Name (Legal Business Name): SIMON LUKOSE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E 55TH ST
NEW YORK NY
10022-3205
US

IV. Provider business mailing address

700 HICKSVILLE RD STE 205
BETHPAGE NY
11714-3472
US

V. Phone/Fax

Practice location:
  • Phone: 646-754-2000
  • Fax: 646-754-2000
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number332243
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: