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General NPI Number Information
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NPI Number | 1982967758
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTHCARE OF HAWTHORNE LLC
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 219 LAFAYETTE AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-1904
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Country | US
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Telephone | 201-543-9992
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4157
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City | RIVER EDGE
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State | NJ
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Zip | 07661-4157
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Country | US
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Telephone | 201-543-9992
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LUIS FREDY LUNA
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Credential | M.D.
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Telephone | 201-543-9992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA07806100
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License Number State | NJ
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