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General NPI Number Information
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NPI Number | 1962353797
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Entity Type | Organization
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Legal Business Name | LUMINATE MEDICAL MSO LLC
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Dates
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Enumeration Date | 02/06/2026
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 169 MADISON AVE STE 11225
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City | NEW YORK
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State | NY
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Zip | 10016-5101
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Country | US
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Telephone | 855-600-0479
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Fax | 888-522-6358
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Provider Business Mailing Address
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Address Line | 169 MADISON AVE STE 11225
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City | NEW YORK
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State | NY
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Zip | 10016-5101
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Country | US
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Telephone | 855-600-0479
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Fax | 888-522-6358
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Authorized Official
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Title or Position | VP PHARMACY & CARE DELIVERY
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Name | MRS. TANYA L GOLOVANOFF
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Credential | GOLOVANOFF
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Telephone | 720-412-2583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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