Healthcare Provider Details

I. General information

NPI: 1215298369
Provider Name (Legal Business Name): RISHI LUMBA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST
BROOKLYN NY
11220-2508
US

IV. Provider business mailing address

150 55TH ST
BROOKLYN NY
11220-2508
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-6375
  • Fax: 718-630-6322
Mailing address:
  • Phone: 718-630-6375
  • Fax: 718-630-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number289631
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number289631
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: