Provider Demographics
NPI:1972690832
Name:LUO, XIANG NONG (MD)
Entity Type:Individual
Prefix:
First Name:XIANG
Middle Name:NONG
Last Name:LUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MAIN STREET
Mailing Address - Street 2:DEPT. REHAB MED
Mailing Address - City:ROOSEVELT ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10044
Mailing Address - Country:US
Mailing Address - Phone:212-318-4500
Mailing Address - Fax:718-776-6823
Practice Address - Street 1:21616 UNION TURNPIKE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364
Practice Address - Country:US
Practice Address - Phone:718-465-4000
Practice Address - Fax:718-776-6823
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215472208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02121460Medicaid
NY07056GMedicare PIN
NY0629J1Medicare PIN
NY02121460Medicaid