MEDICARE: ALYSSA LUKENOVICH

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	235Z00000X	Speech-Language Pathologist	026307	NY

General Provider Information

NPI Number	:	1518401330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA LUKENOVICH

Provider Business Mailing Address
First Line	:	11 PINE HOLLOW CT
Second Line	:
City	:	GREENLAWN
State	:	NY
Zip	:	11740-2205
Country	:	US
Telephone Number	:	631-988-1071
Fax Number	:

Provider Business Practice Location Address
First Line	:	7702 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6628
Country	:	US
Telephone Number	:	718-424-7700
Fax Number	:

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

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	02/24/2025

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Directions to “ ALYSSA LUKENOVICH ” Practice Location

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