Provider Demographics
NPI:1710011465
Name:LUGO COMPREHENSIVE PT SERVICES
Entity Type:Organization
Organization Name:LUGO COMPREHENSIVE PT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ECS
Authorized Official - Phone:646-361-1501
Mailing Address - Street 1:117 CHARLOTTE TER
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2406
Mailing Address - Country:US
Mailing Address - Phone:646-361-1501
Mailing Address - Fax:
Practice Address - Street 1:515 NECKAR AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4511
Practice Address - Country:US
Practice Address - Phone:646-361-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025272261QP2000X
NJ40QA01210900261QP2000X
MD22051261QP2000X
PAPT019858261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy