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NPI Code Detail

MEDICARE: MR. CLARENCE B. LUNA RPT

MEDICARE: MR. CLARENCE B. LUNA RPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist
2225100000XPhysical Therapist022433-1NY

General Provider Information

NPI Number : 1518043983
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLARENCE B. LUNA RPT
Provider Business Mailing Address
First Line : 18007 90TH AVE
Second Line : APT 1
City : JAMAICA
State : NY
Zip : 11432-4703
Country : US
Telephone Number : 347-353-0299
Fax Number :
Provider Business Practice Location Address
First Line : 817 E 180TH ST
Second Line :
City : BRONX
State : NY
Zip : 10460-1305
Country : US
Telephone Number : 718-355-9652
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2006
Last Update Date : 08/22/2019

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