1992812317 NPI number — LUTHERAN MEDICAL CENTER

Table of content: (NPI 1992812317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992812317 NPI number — LUTHERAN MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARIBBEAN AMERICAN FAMILY HEALTH CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992812317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
367 EMERSON PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY STREAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11580-2832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-792-6609
Provider Business Mailing Address Fax Number:
718-940-2914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3414 CHURCH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-940-9425
Provider Business Practice Location Address Fax Number:
718-940-2914
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOUIS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
ANDRE
Authorized Official Title or Position:
FAMILY PRACTICE MD
Authorized Official Telephone Number:
718-940-9425

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  231883 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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