Organization
NYU LUTHERAN MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY DELLACERRA V.P. (VP OF MANAGED CARE & REVENUE COMPLI)
(718) 630-7103
Entity
Organization
Contact information
Practice address
150 55TH ST, BROOKLYN, NY 11220-2559
(718) 630-7000
(718) 630-7437
Mailing address
5800 3RD AVE, LUTHERAN MEDICAL CENTER MANAGED CARE DEPARTMENT, BROOKLYN, NY 11220-3702
(718) 630-7103
(718) 630-7437
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
7001019H
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000065
BLUE CROSS BLUE SHIELD
NY
05
—
00243729
—
NY
05
—
01258300
—
NY
01
—
4100973
GHI
NY
01
—
44800
WELLCARE
NY
01
—
90011
ELDERPLAN
NY
01
—
F0065
HIP
NY
01
—
H04049
OXFORD
NY
Enumeration date
05/17/2006
Last updated
08/17/2018
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