1235323502 NPI number — LUTHERAN SOCIAL SERVICES OF NEW YORK

Table of content: (NPI 1235323502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235323502 NPI number — LUTHERAN SOCIAL SERVICES OF NEW YORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN SOCIAL SERVICES OF NEW YORK
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:
Provider Other Organization Name Type Code:
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:
1235323502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
475 RIVERSIDE DRIVE
Provider Second Line Business Mailing Address:
SUITE 1244
Provider Business Mailing Address City Name:
NEW YORK CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10115-0037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-870-1171
Provider Business Mailing Address Fax Number:
212-870-1105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 1244
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10115-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-870-1171
Provider Business Practice Location Address Fax Number:
212-870-1105
Provider Enumeration Date:
08/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAMUELS
Authorized Official First Name:
SELENA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL ASSURANCE COORDINATOR
Authorized Official Telephone Number:
212-870-1171

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00343408 . This is a "MEDICAID PROVIDER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com