=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134042799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LASANTE HEALTH CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2026
-----------------------------------------------------
Last Update Date | 07/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 69 BROOKSIDE AVE
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10918-1302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-246-5700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 672 PARKSIDE AVE STE 2
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11226-2990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | GEDALYA BLUMENFRUCHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-246-5700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------