Provider Demographics
NPI:1538111653
Name:NYU LUTHERAN MEDICAL CENTER
Entity Type:Organization
Organization Name:NYU LUTHERAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF MANAGED CARE & REVENUE COMPLI
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLACERRA
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:718-630-7103
Mailing Address - Street 1:5800 3RD AVE
Mailing Address - Street 2:LUTHERAN MEDICAL CENTER MANAGED CARE DEPARTMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3702
Mailing Address - Country:US
Mailing Address - Phone:718-630-7103
Mailing Address - Fax:718-630-7437
Practice Address - Street 1:150 55TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2559
Practice Address - Country:US
Practice Address - Phone:718-630-7000
Practice Address - Fax:718-630-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001019H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY90011OtherELDERPLAN
NY000065OtherBLUE CROSS BLUE SHIELD
NY01258300Medicaid
NYH04049OtherOXFORD
NY00243729Medicaid
NY4100973OtherGHI
NY44800OtherWELLCARE
NYF0065OtherHIP
NY00243729Medicaid
NYF0065OtherHIP
NY000065OtherBLUE CROSS BLUE SHIELD
NY4100973OtherGHI
NY=========OtherLOCAL 1199
NYH04049OtherOXFORD
NY01258300Medicaid
NY=========OtherHEALTHFIRST