Provider Demographics
NPI:1033948443
Name:LUKOVSKY, MATTHEW MARK (FNP)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MARK
Last Name:LUKOVSKY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1209
Mailing Address - Country:US
Mailing Address - Phone:203-417-2608
Mailing Address - Fax:
Practice Address - Street 1:4580 NY-28
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NY
Practice Address - Zip Code:13807
Practice Address - Country:US
Practice Address - Phone:607-547-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF354326207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology