Basic Information
| Provider Information | |||||||||
| NPI: | 1487812624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUGO | ||||||||
| FirstName: | JOANELLE | ||||||||
| MiddleName: | Z | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 462 1ST AVE DEPT OF SURGERY | ||||||||
| Address2: | NBV 15SOUTH5 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100169196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122632977 | ||||||||
| FaxNumber: | 2122638640 | ||||||||
| Practice Location | |||||||||
| Address1: | 462 1ST AVE DEPT OF SURGERY | ||||||||
| Address2: | NBV 15SOUTH5 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100169196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122632977 | ||||||||
| FaxNumber: | 2122638640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2008 | ||||||||
| LastUpdateDate: | 02/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 269098 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.