Provider Demographics
NPI:1235323502
Name:LUTHERAN SOCIAL SERVICES OF NEW YORK
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-870-1171
Mailing Address - Street 1:475 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 1244
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10115-0037
Mailing Address - Country:US
Mailing Address - Phone:212-870-1171
Mailing Address - Fax:212-870-1105
Practice Address - Street 1:475 RIVERSIDE DR
Practice Address - Street 2:SUITE 1244
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10115-0002
Practice Address - Country:US
Practice Address - Phone:212-870-1171
Practice Address - Fax:212-870-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00343408OtherMEDICAID PROVIDER