Healthcare Provider Details

I. General information

NPI: 1376636555
Provider Name (Legal Business Name): MIGUEL LUCIANO RT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SOUTHERN BLVD
BRONX NY
10460-5980
US

IV. Provider business mailing address

3164 30TH ST APT 31
LONG ISLAND CITY NY
11106-2859
US

V. Phone/Fax

Practice location:
  • Phone: 718-589-1600
  • Fax:
Mailing address:
  • Phone: 718-545-8782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number002002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: