Organization Name: | DMITRI N. LUKE, D.P.M. L.L.C. |
NPI Number: | 1326315763 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DMITRI N. LUKE (OWNER) |
Mailing Address: | 26 N Kinderkamack Rd Montvale |
State: | NJ US |
Postal Code: | 076452109 |
Phone Number: | 2015730555 |
Fax Number: | 2014761349 |
NPI Enumeration Date: | 11/30/2011 |
NPI Last Update Date: | 11/30/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP1100X |
License Number: | 25MD00295700 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Podiatric |
Taxonomy Definition: |