MEDICARE: LUTHERAN MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	231883	NY

General Provider Information

NPI Number	:	1992812317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHERAN MEDICAL CENTER

Provider Business Mailing Address
First Line	:	367 EMERSON PL
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-2832
Country	:	US
Telephone Number	:	516-792-6609
Fax Number	:	718-940-2914

Provider Business Practice Location Address
First Line	:	3414 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2714
Country	:	US
Telephone Number	:	718-940-9425
Fax Number	:	718-940-2914

Authorized Official
Title or Position	:	FAMILY PRACTICE MD
Name	:	DR. JOSEPH ANDRE LOUIS
Credential	:	MD
Telephone Number	:	718-940-9425

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/21/2022

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