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General NPI Number Information
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NPI Number | 1245635200
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Entity Type | Organization
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Legal Business Name | NYU LUTHERAN MEDICAL CENTER
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 150 55TH ST
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City | BROOKLYN
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State | NY
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Zip | 11220-2508
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Country | US
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Telephone | 718-630-7000
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Fax | 718-630-7437
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Provider Business Mailing Address
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Address Line | 5800 3RD AVE MANAGED CARE DEPT.
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City | BROOKLYN
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State | NY
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Zip | 11220-3702
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Country | US
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Telephone | 718-630-7103
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Fax | 718-630-7437
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Authorized Official
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Title or Position | VP OF MANAGED CARE
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Name | MR. GARY DELLACERRA
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Credential |
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Telephone | 718-630-7103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 7001019H
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License Number State | NY
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