Provider Demographics
NPI:1568749364
Name:LUNA MEDICAL CARE PC
Entity Type:Organization
Organization Name:LUNA MEDICAL CARE PC
Other - Org Name:MOBILE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HONGBIAO
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:716-204-7458
Mailing Address - Street 1:656 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1836
Mailing Address - Country:US
Mailing Address - Phone:716-204-7458
Mailing Address - Fax:
Practice Address - Street 1:656 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1836
Practice Address - Country:US
Practice Address - Phone:716-204-7458
Practice Address - Fax:716-883-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2019-04-10
Deactivation Date:2019-04-02
Deactivation Code:
Reactivation Date:2019-04-10
Provider Licenses
StateLicense IDTaxonomies
NY255538261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty