Basic Information
| Provider Information | |||||||||
| NPI: | 1497758734 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCAS | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 WESTCHESTER AVE | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | PURCHASE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105772552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142497000 | ||||||||
| FaxNumber: | 9142497032 | ||||||||
| Practice Location | |||||||||
| Address1: | 1421 3RD AVE | ||||||||
| Address2: | PENTHOUSE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100281802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128765400 | ||||||||
| FaxNumber: | 2128282344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 12/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 183122 | NY | Y | Other Service Providers | Specialist | 174400000X | 037168 | CT | N | Other Service Providers | Specialist |
No ID Information.