Provider Demographics
NPI:1386811412
Name:HUNTINGTON PULMONARY PC
Entity type:Organization
Organization Name:HUNTINGTON PULMONARY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-351-1144
Mailing Address - Street 1:120 NEW YORK AVENUE
Mailing Address - Street 2:SUITE 6W
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2743
Mailing Address - Country:US
Mailing Address - Phone:631-351-1144
Mailing Address - Fax:631-351-1143
Practice Address - Street 1:120 NEW YORK AVENUE
Practice Address - Street 2:SUITE 6W
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2743
Practice Address - Country:US
Practice Address - Phone:631-351-1144
Practice Address - Fax:631-351-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEM401Medicare UPIN