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General NPI Number Information
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NPI Number | 1104167295
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Entity Type | Organization
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Legal Business Name | LUIS O HERRERA
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Dates
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Enumeration Date | 03/14/2013
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 43 CHURCH ST
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City | FREEPORT
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State | NY
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Zip | 11520-3830
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Country | US
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Telephone | 516-223-2900
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Fax | 516-223-7320
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Provider Business Mailing Address
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Address Line | 43 CHURCH ST
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City | FREEPORT
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State | NY
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Zip | 11520-3830
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Country | US
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Telephone | 516-223-2900
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Fax | 516-223-7320
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Authorized Official
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Title or Position | MD
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Name | DR. LUIS O HERRERA
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Credential |
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Telephone | 516-223-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 244911
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 262675
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 196850
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License Number State | NY
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