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General NPI Number Information
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NPI Number | 1326205691
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Entity Type | Individual
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Provider Name | JOHN M LUCKHURST M.S.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 249 GLENWOOD RD ARTICLE 16 CLINIC AUDIOLOGY
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City | BINGHAMTON
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State | NY
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Zip | 13904-0000
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Country | US
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Telephone | 607-240-4656
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 STATE ROUTE 26
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City | VESTAL
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State | NY
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Zip | 13850-0000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 000866-1
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License Number State | NY
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