=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841235686
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARSHALL L LUKOFF D.P.M
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2006
-----------------------------------------------------
Last Update Date | 11/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 CONGRESS ST 1D
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02169-0908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-479-7921
-----------------------------------------------------
Fax | 617-774-1458
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 CONGRESS ST 1D
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02169-0908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-479-7921
-----------------------------------------------------
Fax | 617-774-1458
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 1498
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------