MEDICARE: SHANTILAL LUNIA MD

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	2085R0202X	Diagnostic Radiology Physician	121109	NY

General Provider Information

NPI Number	:	1457341786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTILAL LUNIA MD

Provider Business Mailing Address
First Line	:	PO BOX 1362
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-8862
Country	:	US
Telephone Number	:	800-357-4829
Fax Number	:	518-786-1293

Provider Business Practice Location Address
First Line	:	159 JEFFERSON HTS
Second Line	:
City	:	CATSKILL
State	:	NY
Zip	:	12414-1237
Country	:	US
Telephone Number	:	518-943-0212
Fax Number	:

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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