Provider Demographics
NPI:1194053728
Name:DR LUIS F LUNA MD LLC
Entity type:Organization
Organization Name:DR LUIS F LUNA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FREDY
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-341-3782
Mailing Address - Street 1:34 MILL ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-1825
Mailing Address - Country:US
Mailing Address - Phone:973-341-3782
Mailing Address - Fax:973-341-3783
Practice Address - Street 1:34 MILL ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1825
Practice Address - Country:US
Practice Address - Phone:973-341-3782
Practice Address - Fax:973-341-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07806100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0140210Medicaid
NJ0140210Medicaid
NJ168023Medicare PIN