Provider Demographics
NPI:1457326274
Name:HERMANN, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:HERMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE LEVY PLACE
Mailing Address - Street 2:BOX 1149
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-0101
Mailing Address - Fax:212-426-5083
Practice Address - Street 1:100TH ST AND MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-0101
Practice Address - Fax:212-426-5083
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2245461207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00011513OtherRR MEDICARE
NY02290600Medicaid
NY819V51Medicare ID - Type Unspecified
NY02290600Medicaid