Provider Demographics
NPI:1326375007
Name:LUMAWIG, DENNIS GUEVARRA (RPT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:GUEVARRA
Last Name:LUMAWIG
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4058
Mailing Address - Country:US
Mailing Address - Phone:212-539-0257
Mailing Address - Fax:212-677-4853
Practice Address - Street 1:460 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4058
Practice Address - Country:US
Practice Address - Phone:212-539-0257
Practice Address - Fax:212-677-4853
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28546-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist