Healthcare Provider Details

I. General information

NPI: 1366446072
Provider Name (Legal Business Name): CARMEN S LUCIANO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ELM ST STE 101A
MONROE CT
06468-2281
US

IV. Provider business mailing address

324 ELM ST STE 101A
MONROE CT
06468-2281
US

V. Phone/Fax

Practice location:
  • Phone: 203-261-9700
  • Fax: 203-459-8974
Mailing address:
  • Phone: 203-261-9700
  • Fax: 203-459-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000115
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: