Healthcare Provider Details

I. General information

NPI: 1336161603
Provider Name (Legal Business Name): LOUIS H THELUSMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 FORT HAMILTON PARKWAY
BROOKLYN NY
11219-2937
US

IV. Provider business mailing address

11 EAST ARTISAN AVENUE
HUNTINGTON NY
11743-2937
US

V. Phone/Fax

Practice location:
  • Phone: 718-972-9712
  • Fax: 888-849-3996
Mailing address:
  • Phone: 631-367-0366
  • Fax: 888-849-3996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number199382
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: