Provider Demographics
NPI:1255412540
Name:LUKE, ROSEMARY P (NPP)
Entity type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:P
Last Name:LUKE
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 HAMPTON VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2859
Mailing Address - Country:US
Mailing Address - Phone:631-909-2831
Mailing Address - Fax:
Practice Address - Street 1:939 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6066
Practice Address - Country:US
Practice Address - Phone:631-852-1440
Practice Address - Fax:631-852-1448
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400096-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW3051Medicare ID - Type Unspecified
NY0521GHW111Medicare PIN