Basic Information
| Provider Information | |||||||||
| NPI: | 1699742619 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUVISH | ||||||||
| FirstName: | SVETLANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 245574 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112245574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189468586 | ||||||||
| FaxNumber: | 7186977463 | ||||||||
| Practice Location | |||||||||
| Address1: | 2844 OCEAN PARKWAY SUITE 6 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189468585 | ||||||||
| FaxNumber: | 7189463230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 12/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | N006082 | NY | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 02653827 | 05 | NY | MEDICAID |