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General NPI Number Information
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NPI Number | 1326315763
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Entity Type | Organization
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Legal Business Name | DMITRI N. LUKE, D.P.M. L.L.C.
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 26 N KINDERKAMACK RD
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City | MONTVALE
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State | NJ
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Zip | 07645-2109
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Country | US
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Telephone | 201-573-0555
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Fax | 201-476-1349
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Provider Business Mailing Address
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Address Line | 26 N KINDERKAMACK RD
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City | MONTVALE
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State | NJ
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Zip | 07645-2109
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Country | US
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Telephone | 201-573-0555
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Fax | 201-476-1349
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Authorized Official
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Title or Position | OWNER
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Name | DR. DMITRI N. LUKE
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Credential | D.P.M.
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Telephone | 201-573-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 25MD00295700
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License Number State | NJ
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