Provider Demographics
NPI:1851655856
Name:LUTHERAN MEDICAL CENTER
Entity Type:Organization
Organization Name:LUTHERAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUDITSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-710-3511
Mailing Address - Street 1:2011 KENNETH RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5508
Mailing Address - Country:US
Mailing Address - Phone:516-710-3511
Mailing Address - Fax:
Practice Address - Street 1:2011 KENNETH RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5508
Practice Address - Country:US
Practice Address - Phone:516-710-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital