Provider Demographics
NPI:1356404511
Name:LUKOVSKY, YEVGENIA
Entity type:Individual
Prefix:MRS
First Name:YEVGENIA
Middle Name:
Last Name:LUKOVSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10890 BUSTLETON AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116
Mailing Address - Country:US
Mailing Address - Phone:215-676-7622
Mailing Address - Fax:215-934-7822
Practice Address - Street 1:10890 BUSTLETON AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-676-7622
Practice Address - Fax:215-934-7822
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA83594969332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA32324OtherHEALTH PARTNERS
PA0016324220002Medicaid
PA32324OtherHEALTH PARTNERS