Healthcare Provider Details

I. General information

NPI: 1215511944
Provider Name (Legal Business Name): LUKE WEBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

5402 FORT HAMILTON PKWY 6TH FLOOR
BROOKLYN NY
11219
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8700
  • Fax:
Mailing address:
  • Phone: 718-283-8773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number328197
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: