Provider Demographics
NPI:1033235403
Name:LUNA, EDGAR CLIENT (DC)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:CLIENT
Last Name:LUNA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 56TH ST # 6F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3609
Mailing Address - Country:US
Mailing Address - Phone:212-421-6509
Mailing Address - Fax:212-421-6504
Practice Address - Street 1:160 E 56TH ST # 6F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3609
Practice Address - Country:US
Practice Address - Phone:212-421-6509
Practice Address - Fax:212-421-6504
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008389-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX81111Medicare ID - Type UnspecifiedPROVIDER ID NUMBER
NYU63840Medicare UPIN