Organization
LUTHERAN MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY DELLACERRA V.P. (VP MANAGED CARE & REVENUE COMPLIANC)
(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
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
7001019H
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00243729
—
NY
Enumeration date
09/13/2006
Last updated
09/08/2008
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