Provider Demographics
NPI:1720072465
Name:LUVERA, VINCENT J (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:LUVERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:286 FAYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GALWAY
Mailing Address - State:NY
Mailing Address - Zip Code:12074-3426
Mailing Address - Country:US
Mailing Address - Phone:518-883-3283
Mailing Address - Fax:518-347-5330
Practice Address - Street 1:600 MCCLELLAN ST
Practice Address - Street 2:ST CLAIRES HOSPITAL WOUND CARE CENTER
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1009
Practice Address - Country:US
Practice Address - Phone:518-347-5442
Practice Address - Fax:518-347-5330
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180500-1207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
016672OtherEMPIRE
NY01422375Medicaid
100056652606OtherCDPHP
000406638001OtherBLUES
784649OtherMVP
S30758Medicare UPIN