Provider Demographics
NPI:1184979155
Name:LUCIANO, ANAMARIE
Entity type:Individual
Prefix:MS
First Name:ANAMARIE
Middle Name:
Last Name:LUCIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BLAIR AVENUE
Mailing Address - Street 2:3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465
Mailing Address - Country:US
Mailing Address - Phone:646-305-6005
Mailing Address - Fax:
Practice Address - Street 1:230 BLAIR AVE
Practice Address - Street 2:3
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3749
Practice Address - Country:US
Practice Address - Phone:646-305-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1786284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist