OrganizationLucky Care Medical, PcInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address2108 2nd Ave, New York, NY 10029-3731(212) 876-8590(718) 850-6345PECOS EnrollmentBased on the most recent information from CMS, provider Lucky Care Medical, Pc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1174796650Provider TypeOrganizationFull NameLucky Care Medical, PcSubpartNoEnumeration Date4/7/2008Last Updated3/7/2023Contact InformationPractice LocationPractice Address2108 2nd Ave, New York, NY 10029-3731Phone(212) 876-8590Fax(212) 360-1844Mailing LocationMailing Address13876 Queens Blvd Fl 1, Briarwood, NY 11435-2930Phone(718) 850-6345Fax(718) 559-4895Authorized OfficialNameLucky, Clyde (President)Phone(212) 876-8590Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense167799New YorkProvider IdentifiersIDDescriptionIssuerID01029056DescriptionMedicaidIssuerUnlistedNew York