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NPI Code Detail

MEDICARE: REA MAECA LURA RPT

MEDICARE: REA MAECA LURA 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
12081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician049926NY

General Provider Information

NPI Number : 1629775051
Entity Type Code : Individual
Provider Name (Legal Business Name) : REA MAECA LURA RPT
Provider Business Mailing Address
First Line : 124 E 117TH ST APT 3J
Second Line :
City : NEW YORK
State : NY
Zip : 10035-4600
Country : US
Telephone Number : 757-291-1289
Fax Number :
Provider Business Practice Location Address
First Line : 2432 GRAND CONCOURSE
Second Line :
City : BRONX
State : NY
Zip : 10458-5204
Country : US
Telephone Number : 718-551-0202
Fax Number : 718-551-0202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2023
Last Update Date : 02/05/2026

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Directions to “ REA MAECA LURA RPT” Practice Location

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