Basic Information
| Provider Information | |||||||||
| NPI: | 1184115917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUKE | ||||||||
| FirstName: | NEETI | ||||||||
| MiddleName: | PRERANA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | NASSAU UNIVERSITY MEDICAL CENTRE, | ||||||||
| Address2: | 2201 HEMPSTEAD TURNPIKE | ||||||||
| City: | EAST MEADOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165720123 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | NASSAU UNIVERSITY MEDICAL CENTRE, | ||||||||
| Address2: | 2201 HEMPSTEAD TURNPIKE | ||||||||
| City: | EAST MEADOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165720123 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2018 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 01/22/2019 | ||||||||
| NPIReactivationDate: | 01/31/2019 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.