Provider Demographics
NPI:1982875183
Name:NYU LUTHERAN MEDICAL CENTER
Entity Type:Organization
Organization Name:NYU LUTHERAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MANAGED CARE & REVENUE COMPLIANC
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLACERRA
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:718-630-7103
Mailing Address - Street 1:5800 3RD AVE
Mailing Address - Street 2:LUTHERAN MEDICAL CENTER MANAGED CARE DEPARTMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3702
Mailing Address - Country:US
Mailing Address - Phone:718-630-7477
Mailing Address - Fax:718-630-7437
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:718-630-7133
Practice Address - Fax:718-630-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12263341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01228720Medicaid
NY330306Medicare PIN