Individual
SHANE LUKOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24 HOSPITAL AVE, DANBURY, CT 06810-6099
(203) 739-6752
Mailing address
40 MAYFAIR AVE, WEST HEMPSTEAD, NY 11552-1513
(516) 849-0761
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
69316
CT
207Q00000X
Family Medicine Physician
MT216301
PA
Other
Enumeration date
06/19/2018
Last updated
01/09/2024
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