Healthcare Provider Details

I. General information

NPI: 1053496224
Provider Name (Legal Business Name): GEM-ESTELLE M LUCAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GEM M LUCAS

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 W 110TH ST APT 1E
NEW YORK NY
10025-2021
US

IV. Provider business mailing address

535 W 110TH ST APT 1E
NEW YORK NY
10025-2021
US

V. Phone/Fax

Practice location:
  • Phone: 212-280-4740
  • Fax: 212-280-4743
Mailing address:
  • Phone: 212-280-4740
  • Fax: 212-280-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB08029600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: