Provider Demographics
NPI:1336161603
Name:THELUSMOND, LOUIS H (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:H
Last Name:THELUSMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EAST ARTISAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2937
Mailing Address - Country:US
Mailing Address - Phone:631-367-0366
Mailing Address - Fax:888-849-3996
Practice Address - Street 1:4801 FORT HAMILTON PARKWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2937
Practice Address - Country:US
Practice Address - Phone:718-972-9712
Practice Address - Fax:888-849-3996
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199382207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01642415Medicaid
NY032631Medicare ID - Type Unspecified
NY01642415Medicaid