Individual
MS. DIANE B. LUCKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MIDWIFE
Contact information
Practice address
79 GRAND AVE, MASSAPEQUA, NY 11758-4905
(516) 798-3376
(516) 798-5882
Mailing address
200 GARDEN CITY PLAZA, SUITE 100, GARDEN CITY, NY 11530
(516) 663-6400
(516) 663-6404
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
376143-1
NY
367A00000X
Advanced Practice Midwife
F000126
NY
367A00000X
Advanced Practice Midwife
Primary
F000126-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F00126
MIDWIFE LICENSE
NY
Enumeration date
10/25/2006
Last updated
03/07/2023
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