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General NPI Number Information
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NPI Number | 1710011465
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Entity Type | Organization
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Legal Business Name | LUGO COMPREHENSIVE PT SERVICES
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 515 NECKAR AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10304-4511
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Country | US
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Telephone | 646-361-1501
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Fax |
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Provider Business Mailing Address
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Address Line | 117 CHARLOTTE TER
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City | ROSELLE PARK
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State | NJ
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Zip | 07204-2406
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Country | US
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Telephone | 646-361-1501
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN E LUGO
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Credential | PT, ECS
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Telephone | 646-361-1501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA01210900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 22051
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT019858
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 025272
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License Number State | NY
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