Provider Demographics
NPI:1558436360
Name:LUTHERAN MEDICAL CENTER
Entity Type:Organization
Organization Name:LUTHERAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHARITONOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-437-5272
Mailing Address - Street 1:150 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2559
Mailing Address - Country:US
Mailing Address - Phone:718-437-5272
Mailing Address - Fax:
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:718-437-5272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208942281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01911522Medicaid
NYG86603Medicare UPIN
64M551Medicare ID - Type Unspecified