Provider Demographics
NPI:1023371838
Name:LUGO, AIDA M (MSED)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:M
Last Name:LUGO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3508
Mailing Address - Country:US
Mailing Address - Phone:347-739-2263
Mailing Address - Fax:516-771-1485
Practice Address - Street 1:651 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3508
Practice Address - Country:US
Practice Address - Phone:347-739-2263
Practice Address - Fax:516-771-1485
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist