MEDICARE: DR. SERGEY LUGINA D.O.

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	207Q00000X	Family Medicine Physician	222476	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275603250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERGEY LUGINA D.O.

Provider Business Mailing Address
First Line	:	42 GOODALL ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3396
Country	:	US
Telephone Number	:	646-270-8647
Fax Number	:

Provider Business Practice Location Address
First Line	:	3049 BRIGHTON 6TH STREET
Second Line	:	UNIT CU1
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6409
Country	:	US
Telephone Number	:	718-934-0322
Fax Number	:	718-934-0994

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	06/18/2014

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