Provider Demographics
NPI:1053873893
Name:LUCHANA, VIDAL EVAN (DO)
Entity type:Individual
Prefix:DR
First Name:VIDAL EVAN
Middle Name:
Last Name:LUCHANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:VIDAL
Other - Middle Name:EVAN
Other - Last Name:LUCHANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:5636 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5046
Mailing Address - Country:US
Mailing Address - Phone:718-670-1347
Mailing Address - Fax:718-670-2456
Practice Address - Street 1:120 NEW YORK AVE STE 4W
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2743
Practice Address - Country:US
Practice Address - Phone:631-423-9809
Practice Address - Fax:631-271-3205
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program