=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336161603
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOUIS H THELUSMOND MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 09/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4801 FORT HAMILTON PARKWAY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11219-2937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-972-9712
-----------------------------------------------------
Fax | 888-849-3996
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 EAST ARTISAN AVENUE
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11743-2937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-367-0366
-----------------------------------------------------
Fax | 888-849-3996
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 199382
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------