Healthcare Provider Details

I. General information

NPI: 1952555062
Provider Name (Legal Business Name): CARMEN S LUCIANO DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ELM ST SUITE 101A
MONROE CT
06468-2280
US

IV. Provider business mailing address

324 ELM ST SUITE 101A
MONROE CT
06468-2280
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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberCT000115
License Number StateCT

VIII. Authorized Official

Name: DR. CARMEN S LUCIANO
Title or Position: OWNER
Credential: DPM
Phone: 203-261-9700