Healthcare Provider Details

I. General information

NPI: 1154294262
Provider Name (Legal Business Name): LUCA BOSCOLO BIELO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E 77TH ST APT 2D
NEW YORK NY
10075-2199
US

IV. Provider business mailing address

250 E 77TH ST APT 2D
NEW YORK NY
10075-2199
US

V. Phone/Fax

Practice location:
  • Phone: 646-234-6585
  • Fax:
Mailing address:
  • Phone: 646-234-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberP134657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: