Basic Information
Provider Information
NPI: 1477619880
EntityType: 2
ReplacementNPI:  
OrganizationName: LINCOLN HOSPITAL
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 234 E 149TH ST
Address2: 110
City: BRONX
State: NY
PostalCode: 104515504
CountryCode: US
TelephoneNumber: 7185795000
FaxNumber: 7185795045
Practice Location
Address1: 234 E 149TH ST
Address2: 110
City: BRONX
State: NY
PostalCode: 104515504
CountryCode: US
TelephoneNumber: 7185795000
FaxNumber: 7185795045
Other Information
ProviderEnumerationDate: 12/29/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LOUBEAU
AuthorizedOfficialFirstName: MICHELINE
AuthorizedOfficialMiddleName: O.
AuthorizedOfficialTitleorPosition: STAFF PSYCHIATRIST OPD
AuthorizedOfficialTelephone: 7185795000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X132325NYY HospitalsGeneral Acute Care Hospital 

No ID Information.


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