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General NPI Number Information
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NPI Number | 1760265540
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Entity Type | Organization
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Legal Business Name | LUMINESCENCE MEDICAL PLLC
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 1202 TROY SCHENECTADY ROAD BUILDING #2
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City | LATHAM
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State | NY
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Zip | 12110
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Country | US
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Telephone | 518-389-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 TROY SCHENECTADY RAOD BUILDING #2
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City | LATHAM
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State | NY
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Zip | 12110
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Country | US
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Telephone | 518-389-6100
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Fax |
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Authorized Official
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Title or Position | PARTNER/PHYSICIAN
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Name | DR. PRAJESH GHIMIRE
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Credential | MD
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Telephone | 518-330-2843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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