Healthcare Provider Details

I. General information

NPI: 1134042799
Provider Name (Legal Business Name): LASANTE HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 BROOKSIDE AVE
CHESTER NY
10918-1302
US

IV. Provider business mailing address

672 PARKSIDE AVE STE 2
BROOKLYN NY
11226-2990
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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