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1538819909 NPI number — LUMIN HEALTH PG

NPI Number: 1538819909
Health Care Provider/Practitioner: LUMIN HEALTH PG

Information about “1538819909” NPI (LUMIN HEALTH PG) exists in 1538819909 in HTML format HTML  |  1538819909 in plain Text format TXT  |  1538819909 in PDF (Portable Document Format) PDF  |  1538819909 in an XML format XML  formats.

NPI Number : 1538819909 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1538819909",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LUMIN HEALTH PG",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10 LANGLEY RD STE 200",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEWTON",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02459-1972",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "617-863-8810",
    "MailingAddressFaxNumber": "617-863-8844",
    "FirstLinePracticeLocationAddress": "10 LANGLEY RD STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEWTON",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "02459-1972",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "617-863-8810",
    "PracticeLocationAddressFaxNumber": "617-863-8844",
    "EnumerationDate": "03/28/2022",
    "LastUpdateDate": "11/26/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "YUDKOFF",
    "AuthorizedOfficialFirstName": "BENJAMIN",
    "AuthorizedOfficialMiddleName": "LOUIS",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "201-953-0432",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0801X",
          "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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