Provider Demographics
NPI:1194767079
Name:LURIO, JOSEPH GLEN MESSNER (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GLEN MESSNER
Last Name:LURIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6901
Mailing Address - Country:US
Mailing Address - Phone:212-865-4104
Mailing Address - Fax:212-864-5375
Practice Address - Street 1:690 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6901
Practice Address - Country:US
Practice Address - Phone:212-865-4104
Practice Address - Fax:212-864-5375
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00903700Medicaid
NY17E481Medicare ID - Type Unspecified
NY00903700Medicaid