MEDICARE: LUMINARY CARE OF NY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1972399582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMINARY CARE OF NY LLC

Provider Business Mailing Address
First Line	:	1280 LEXINGTON AVE
Second Line	:	FRONT 2 #1234
City	:	NEW YORK
State	:	NY
Zip	:	10028
Country	:	US
Telephone Number	:	347-837-2088
Fax Number	:

Provider Business Practice Location Address
First Line	:	4212 28TH ST APT 42C
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-6253
Country	:	US
Telephone Number	:	347-837-2088
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	SHAIFUL CHOWDHURY
Credential	:
Telephone Number	:	347-837-2088

Provider Enumeration Date	:	04/18/2025
Last Update Date	:	04/18/2025

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