Individual
LUCKY LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2418 E YORK ST, PHILADELPHIA, PA 19125-3006
(833) 351-8255
Mailing address
109 W 27TH ST RM 5S, NEW YORK, NY 10001-6208
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
OT019118
PA
Other
Enumeration date
06/18/2019
Last updated
06/24/2025
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