Healthcare Provider Details

I. General information

NPI: 1720072465
Provider Name (Legal Business Name): VINCENT J LUVERA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MCCLELLAN ST ST CLAIRES HOSPITAL WOUND CARE CENTER
SCHENECTADY NY
12304-1009
US

IV. Provider business mailing address

286 FAYVILLE RD
GALWAY NY
12074-3426
US

V. Phone/Fax

Practice location:
  • Phone: 518-347-5442
  • Fax: 518-347-5330
Mailing address:
  • Phone: 518-883-3283
  • Fax: 518-347-5330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number180500-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: