Individual
LUCKO JEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
205 GIBBS POND RD, NESCONSET, NY 11767-2265
(631) 432-9691
(631) 257-5866
Mailing address
205 GIBBS POND RD, NESCONSET, NY 11767-2265
(631) 432-9691
(631) 257-5866
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04582707
—
NY
Enumeration date
01/28/2018
Last updated
01/28/2018
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