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NPI Code Detail

MEDICARE: MS. MELANIE A LUCAS MSOTR/L

MEDICARE: MS. MELANIE A LUCAS MSOTR/L
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
1172V00000XCommunity Health Worker0152671NY

General Provider Information

NPI Number : 1265749766
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELANIE A LUCAS MSOTR/L
Provider Business Mailing Address
First Line : 400 ARGYLE RD
Second Line : LH5 APARTMENT
City : BROOKLYN
State : NY
Zip : 11218-5459
Country : US
Telephone Number : 646-353-9998
Fax Number :
Provider Business Practice Location Address
First Line : 1642 63RD ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11204-2713
Country : US
Telephone Number : 718-234-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2010
Last Update Date : 09/03/2010

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