=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265787840
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | Adam Lukeman
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2012
-----------------------------------------------------
Last Update Date | 07/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 West 96th Street Room 2
-----------------------------------------------------
City | New York
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | (347) 699-7319
-----------------------------------------------------
Fax | 347-294-3498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 Bedford Avenue Apt 6
-----------------------------------------------------
City | Brooklyn
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | (347) 699-7319
-----------------------------------------------------
Fax | 347-294-3498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical
-----------------------------------------------------
License Number | 72 084998
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------