MEDICARE: LINDA LUKASCHEK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	007703-1	NY

General Provider Information

NPI Number	:	1255993739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA LUKASCHEK

Provider Business Mailing Address
First Line	:	18 BARNES ST
Second Line	:
City	:	PATCHOGUE
State	:	NY
Zip	:	11772-3204
Country	:	US
Telephone Number	:	631-627-0589
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 BRENTWOOD RD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5704
Country	:	US
Telephone Number	:	665-631-4960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	07/03/2019

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Directions to “ LINDA LUKASCHEK ” Practice Location

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