Provider Demographics
NPI:1528098621
Name:LURIA, JEFFRY (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:
Last Name:LURIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 GROVENORS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12035-2003
Mailing Address - Country:US
Mailing Address - Phone:518-296-8524
Mailing Address - Fax:518-296-8536
Practice Address - Street 1:847 GROVENORS CORNERS RD
Practice Address - Street 2:
Practice Address - City:CENTRAL BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12035-2003
Practice Address - Country:US
Practice Address - Phone:518-296-8524
Practice Address - Fax:518-296-8536
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004773103T00000X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS-04773-8BOtherWORKER'S COMPENSATION
NY51607BMedicare ID - Type Unspecified