MEDICARE: DR. ILANA JULIETT DELUCA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	279391	NY

General Provider Information

NPI Number	:	1174812614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ILANA JULIETT DELUCA M.D.

Provider Business Mailing Address
First Line	:	18 STUYVESANT OVAL APT 12B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-2251
Country	:	US
Telephone Number	:	917-678-4212
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 STUYVESANT OVAL APT 12B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-2251
Country	:	US
Telephone Number	:	917-678-4212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	08/16/2015

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