Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | AN006347 | NY |
N | 213ES0000X | Sports Medicine | AN006347 | NY |
Y | 213ES0103X | Foot & Ankle Surgery | AN006347 | NY |
NPI | 1225299175 |
---|---|
Provider Name | Dr. Fred De Lucia |
First Address | New Hyde Park, NY 11042-1214 |
Second Address | New Hyde Park, NY 11042-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 14/03/2020 |