Provider Demographics
NPI:1154888162
Name:ST. LUKE'S COUNSELING MEDICAL CENTER L.L.C.
Entity type:Organization
Organization Name:ST. LUKE'S COUNSELING MEDICAL CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GA
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-779-3320
Mailing Address - Street 1:59 SEELEY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3120
Mailing Address - Country:US
Mailing Address - Phone:201-428-1040
Mailing Address - Fax:201-428-1161
Practice Address - Street 1:59 SEELEY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3120
Practice Address - Country:US
Practice Address - Phone:201-428-1040
Practice Address - Fax:201-428-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty