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General NPI Number Information
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NPI Number | 1811936529
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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 | 06/06/2006
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Last Update Date | 08/17/2018
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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 | 11220-2559
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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 LUTHERAN MEDICAL CENTER-MANAGED CARE DEPARTMENT
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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 MANAGED CARE & REVENUE COMPLIAN
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Name | MR. GARY DELLACERRA
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Credential | V.P.
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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 | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 7001019H
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License Number State | NY
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