# KELLY LUCAS DPM PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629615588
- **Authorized official:** KELLY M LUCAS DPM (PRESIDENT)
- **Authorized official phone:** (516) 352-4454

## Contact information

- **Practice address:** 925 HEMPSTEAD TPKE STE 110, FRANKLIN SQUARE, NY 11010-3636
- **Practice address phone:** (516) 352-4454
- **Mailing address:** 73 E SHORE RD, HALESITE, NY 11743-1127
- **Mailing address phone:** (516) 352-4454

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 12/10/2019
- **Last updated:** 12/10/2019