Healthcare Provider Details

I. General information

NPI: 1093175952
Provider Name (Legal Business Name): YONG LUO ALLERGY AND ASTHMA P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13329 41ST RD SUITE 1C
FLUSHING NY
11355-3670
US

IV. Provider business mailing address

13329 41ST RD SUITE 1C
FLUSHING NY
11355-3670
US

V. Phone/Fax

Practice location:
  • Phone: 718-475-9606
  • Fax: 718-475-9607
Mailing address:
  • Phone: 718-475-9606
  • Fax: 718-475-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number267414
License Number StateNY

VIII. Authorized Official

Name: YONG LUO
Title or Position: OWNER
Credential: MD
Phone: 718-475-9606