1972690832 NPI number — XIANG NONG LUO MD

Table of content: XIANG NONG LUO MD (NPI 1972690832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972690832 NPI number — XIANG NONG LUO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUO
Provider First Name:
XIANG
Provider Middle Name:
NONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1972690832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE MAIN STREET
Provider Second Line Business Mailing Address:
DEPT. REHAB MED
Provider Business Mailing Address City Name:
ROOSEVELT ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-318-4500
Provider Business Mailing Address Fax Number:
718-776-6823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21616 UNION TURNPIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-465-4000
Provider Business Practice Location Address Fax Number:
718-776-6823
Provider Enumeration Date:
10/10/2006

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: 208100000X , with the licence number:  215472 , 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: 02121460 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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