Provider Demographics
NPI:1134405368
Name:LUTHERAN HOSPTAL
Entity type:Organization
Organization Name:LUTHERAN HOSPTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CATH LAB MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-630-6467
Mailing Address - Street 1:150 55TH ST
Mailing Address - Street 2:ROOM 3-37
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2553
Mailing Address - Country:US
Mailing Address - Phone:718-630-8357
Mailing Address - Fax:718-630-8721
Practice Address - Street 1:150 55TH ST
Practice Address - Street 2:ROOM 3-37
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2553
Practice Address - Country:US
Practice Address - Phone:718-630-8357
Practice Address - Fax:718-630-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007975282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital