Provider Demographics
NPI:1215999099
Name:DELUCA, RICHARD LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOUIS
Last Name:DELUCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:825 E GATE BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2136
Mailing Address - Country:US
Mailing Address - Phone:516-993-0792
Mailing Address - Fax:516-240-6540
Practice Address - Street 1:132 E 76TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2850
Practice Address - Country:US
Practice Address - Phone:212-505-5151
Practice Address - Fax:212-645-3165
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY218396207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02099874Medicaid
NY061616047OtherTIN
NYH24139Medicare UPIN