1720072465 NPI number — DR. VINCENT J LUVERA DO

Table of content: DR. VINCENT J LUVERA DO (NPI 1720072465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720072465 NPI number — DR. VINCENT J LUVERA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUVERA
Provider First Name:
VINCENT
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1720072465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
286 FAYVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALWAY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12074-3426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-883-3283
Provider Business Mailing Address Fax Number:
518-347-5330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MCCLELLAN ST
Provider Second Line Business Practice Location Address:
ST CLAIRES HOSPITAL WOUND CARE CENTER
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12304-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-347-5442
Provider Business Practice Location Address Fax Number:
518-347-5330
Provider Enumeration Date:
09/08/2005

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: 207QG0300X , with the licence number:  180500-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 016672 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01422375 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100056652606 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000406638001 . This is a "BLUES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 784649 . This is a "MVP" identifier . This identifiers is of the category "OTHER".