Individual
JORGE ERNESTO LUGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
61 NEW MAIN ST, 61 NEW MAIN STREET, HAVERSTRAW, NY 10927-1813
(845) 942-4512
(845) 942-4514
Mailing address
PO BOX 380, 61 NEW MAIN STREET, HAVERSTRAW, NY 10927-0380
(845) 942-4512
(845) 942-4514
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
208332
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01814819
—
NY
01
—
040426012056
FIDELIS
NY
01
—
1000000194
AFFINITY
—
01
—
134973
AETNA
—
01
—
172321P
HIP
NY
01
—
221824
WELLCARE
NY
01
—
393729
MVP
NY
01
—
396995
CONNECTICARE
NY
01
—
46V621
EMPIRE BC/BS
NY
01
—
4C5847
HEALTHNET
NY
01
—
5997592
GHI
NY
01
—
P2543357
OXFORD
NY
Enumeration date
04/08/2008
Last updated
05/07/2008
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