Provider Demographics
NPI:1396955100
Name:WOODLAND AVE MEDICAL CENTER PC
Entity type:Organization
Organization Name:WOODLAND AVE MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LUGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-465-4465
Mailing Address - Street 1:6325 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-2036
Mailing Address - Country:US
Mailing Address - Phone:215-729-6026
Mailing Address - Fax:215-729-6046
Practice Address - Street 1:6325 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2036
Practice Address - Country:US
Practice Address - Phone:215-729-6026
Practice Address - Fax:215-729-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007780111N00000X
PADC007780L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty