Healthcare Provider Details

I. General information

NPI: 1639286099
Provider Name (Legal Business Name): LUTHERAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 CHURCH AVE
BROOKLYN NY
11203-2714
US

IV. Provider business mailing address

521 MAPLE ST
WEST HEMPSTEAD NY
11552-3314
US

V. Phone/Fax

Practice location:
  • Phone: 718-940-4949
  • Fax:
Mailing address:
  • Phone: 516-414-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number216962
License Number StateNY

VIII. Authorized Official

Name: DR. TOYCINA E AGUILH-FIGARO
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 718-940-9425