1366446072 NPI number — DR. CARMEN S LUCIANO DPM

Table of content: DR. CARMEN S LUCIANO DPM (NPI 1366446072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366446072 NPI number — DR. CARMEN S LUCIANO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCIANO
Provider First Name:
CARMEN
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366446072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
324 ELM ST
Provider Second Line Business Mailing Address:
STE 101A
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06468-2281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-261-9700
Provider Business Mailing Address Fax Number:
203-459-8974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 ELM ST
Provider Second Line Business Practice Location Address:
STE 101A
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06468-2281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-261-9700
Provider Business Practice Location Address Fax Number:
203-459-8974
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  000115 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 061556408-0002 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: ZS536 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 030000115CT02 . This is a "ANTHEM BLUE CROSS/BLUE SH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1529188 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1952555062 . This is a "DMERC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004006219 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: OV5650 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2178064 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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