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General NPI Number Information
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NPI Number | 1326435819
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Entity Type | Organization
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Legal Business Name | LUNA CARES MEDICAL, PC
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 320 POST AVE SUITE 106
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City | WESTBURY
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State | NY
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Zip | 11590-2257
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Country | US
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Telephone | 347-302-6113
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Fax |
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Provider Business Mailing Address
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Address Line | 320 POST AVE SUITE 106
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City | WESTBURY
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State | NY
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Zip | 11590-2257
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Country | US
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Telephone | 347-302-6113
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BETTY LUNA
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Credential | MD
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Telephone | 347-302-6113
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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 | 212452
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License Number State | NY
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