Healthcare Provider Details

I. General information

NPI: 1053873893
Provider Name (Legal Business Name): VIDAL EVAN LUCHANA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VIDAL EVAN LUCHANA DO

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 08/03/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NEW YORK AVE STE 4W
HUNTINGTON NY
11743-2743
US

IV. Provider business mailing address

120 NEW YORK AVE STE 4W
HUNTINGTON NY
11743-2743
US

V. Phone/Fax

Practice location:
  • Phone: 631-423-9809
  • Fax: 631-271-3205
Mailing address:
  • Phone: 631-423-9809
  • Fax: 631-271-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number316879
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: