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General NPI Number Information
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NPI Number | 1568749364
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Entity Type | Organization
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Legal Business Name | LUNA MEDICAL CARE PC
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 656 ELMWOOD AVE
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City | BUFFALO
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State | NY
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Zip | 14222-1836
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Country | US
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Telephone | 716-204-7458
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Fax | 716-883-8764
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Provider Business Mailing Address
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Address Line | 656 ELMWOOD AVE
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City | BUFFALO
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State | NY
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Zip | 14222-1836
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Country | US
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Telephone | 716-204-7458
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HONGBIAO LIU
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Credential | MD PHD
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Telephone | 716-204-7458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 255538
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License Number State | NY
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