Provider Demographics
NPI:1386698504
Name:LIGHTHOUSE INTERNATIONAL
Entity type:Organization
Organization Name:LIGHTHOUSE INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT, SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, DSW
Authorized Official - Phone:212-821-9484
Mailing Address - Street 1:111 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1202
Mailing Address - Country:US
Mailing Address - Phone:212-821-9200
Mailing Address - Fax:212-821-9710
Practice Address - Street 1:111 E 59TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1202
Practice Address - Country:US
Practice Address - Phone:212-821-9200
Practice Address - Fax:212-821-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002239R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00826444Medicaid
NYCOW131Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYCOW133Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER