1902940968 NPI number — LUCIANO E DE MARCO M.D.

Table of content: LUCIANO E DE MARCO M.D. (NPI 1902940968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902940968 NPI number — LUCIANO E DE MARCO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE MARCO
Provider First Name:
LUCIANO
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1902940968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 COLUMBUS AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALHALLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10595-1732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-761-9117
Provider Business Mailing Address Fax Number:
914-761-7731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 COLUMBUS AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALHALLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10595-1732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-761-9117
Provider Business Practice Location Address Fax Number:
914-761-7731
Provider Enumeration Date:
02/16/2007

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: 207R00000X , with the licence number:  145754 , 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: WP754 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: LD030D1010 . This is a "EMPIRE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0068360 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 30D101 . This is a "MEDICARE ID- TYPE UNSPECIFIED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C0527 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 110014726 . This is a "PALMETTO GBA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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