Healthcare Provider Details

I. General information

NPI: 1497037279
Provider Name (Legal Business Name): ARTHUR DELUCA MD PEDIATRIC PULMONOLOGY OF LONG ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 37TH ST THIRD FLOOR
ASTORIA NY
11103-3809
US

IV. Provider business mailing address

3016 37TH ST THIRD FLOOR
ASTORIA NY
11103-3809
US

V. Phone/Fax

Practice location:
  • Phone: 718-288-1474
  • Fax: 718-278-2430
Mailing address:
  • Phone: 718-288-1474
  • Fax: 718-278-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number191559
License Number StateNY

VIII. Authorized Official

Name: ARTHUR JOHN DELUCA
Title or Position: PHYSICIAN
Credential: MD
Phone: 718-288-1474