Provider Demographics
NPI:1508964008
Name:DELUCA, PHILIP V (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:V
Last Name:DELUCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:972 BRUSH HOLLOW RD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1740
Mailing Address - Country:US
Mailing Address - Phone:516-876-5555
Mailing Address - Fax:516-876-5539
Practice Address - Street 1:480 FOREST AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-2151
Practice Address - Country:US
Practice Address - Phone:516-671-9800
Practice Address - Fax:516-671-9283
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY205461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02134623Medicaid
NY776031Medicare ID - Type Unspecified
NY02134623Medicaid