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General NPI Number Information
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NPI Number | 1396955100
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Entity Type | Organization
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Legal Business Name | WOODLAND AVE MEDICAL CENTER PC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 6325 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19142-2036
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Country | US
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Telephone | 215-729-6026
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Fax | 215-729-6046
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Provider Business Mailing Address
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Address Line | 6325 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19142-2036
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Country | US
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Telephone | 215-729-6026
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Fax | 215-729-6046
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARREN MICHAEL LUGIANO
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Credential | DC
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Telephone | 215-465-4465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC007780
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC007780L
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License Number State | PA
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