Provider Demographics
NPI:1669280525
Name:LUNA WELLNESS INC
Entity type:Organization
Organization Name:LUNA WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLADA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-240-9471
Mailing Address - Street 1:99 PERCY WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2219
Mailing Address - Country:US
Mailing Address - Phone:212-240-9471
Mailing Address - Fax:201-353-2926
Practice Address - Street 1:111 JOHN ST STE 1450
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3122
Practice Address - Country:US
Practice Address - Phone:212-240-9471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty