MEDICARE: LUKE MCBRIDE EDWARDS

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	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	333675	NY
2	208600000X	Surgery Physician	285867	MA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	208D00000X	General Practice Physician	333675	NY

General Provider Information

NPI Number	:	1831693613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE MCBRIDE EDWARDS

Provider Business Mailing Address
First Line	:	PO BOX 2034
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-8034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 LOUISIANA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11239-1526
Country	:	US
Telephone Number	:	516-515-0017
Fax Number	:

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

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	08/14/2025

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