Provider Demographics
NPI:1417128331
Name:LUTHERAN SOCIAL SERVICES OF METROPOLITAN NEW YORK
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF METROPOLITAN NEW YORK
Other - Org Name:LUTHERAN SOCIAL SERVICES OF NEW YORK
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-870-1100
Mailing Address - Street 1:475 RIVERSIDE DR
Mailing Address - Street 2:SUITE 1244
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10115-0002
Mailing Address - Country:US
Mailing Address - Phone:212-870-1100
Mailing Address - Fax:212-870-1101
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:212-870-1100
Practice Address - Fax:212-870-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03001154Medicaid
NY00343408Medicaid