Basic Information
| Provider Information | |||||||||
| NPI: | 1992812317 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LUTHERAN MEDICAL CENTER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CARIBBEAN AMERICAN FAMILY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 367 EMERSON PL | ||||||||
| Address2: | |||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115802832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167926609 | ||||||||
| FaxNumber: | 7189402914 | ||||||||
| Practice Location | |||||||||
| Address1: | 3414 CHURCH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189409425 | ||||||||
| FaxNumber: | 7189402914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LOUIS | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | ANDRE | ||||||||
| AuthorizedOfficialTitleorPosition: | FAMILY PRACTICE MD | ||||||||
| AuthorizedOfficialTelephone: | 7189409425 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 231883 | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.