Healthcare Provider Details

I. General information

NPI: 1548192446
Provider Name (Legal Business Name): LASANTE HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 PARKSIDE AVE
BROOKLYN NY
11226-1506
US

IV. Provider business mailing address

646 PARKSIDE AVE
BROOKLYN NY
11226-1506
US

V. Phone/Fax

Practice location:
  • Phone: 718-246-5700
  • Fax:
Mailing address:
  • Phone: 718-246-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEDALYA BLUMENFRUCHT
Title or Position: CFO
Credential:
Phone: 718-246-5700