Provider Demographics
NPI:1760265540
Name:LUMINESCENCE MEDICAL PLLC
Entity Type:Organization
Organization Name:LUMINESCENCE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GHIMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-330-2843
Mailing Address - Street 1:1202 TROY SCHENECTADY RAOD
Mailing Address - Street 2:BUILDING #2
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110
Mailing Address - Country:US
Mailing Address - Phone:518-389-6100
Mailing Address - Fax:
Practice Address - Street 1:1202 TROY SCHENECTADY ROAD
Practice Address - Street 2:BUILDING #2
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-389-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty