Provider Demographics
NPI:1538819909
Name:LUMIN HEALTH PG
Entity type:Organization
Organization Name:LUMIN HEALTH PG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:YUDKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-953-0432
Mailing Address - Street 1:10 LANGLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1972
Mailing Address - Country:US
Mailing Address - Phone:617-863-8810
Mailing Address - Fax:617-863-8844
Practice Address - Street 1:10 LANGLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1972
Practice Address - Country:US
Practice Address - Phone:617-863-8810
Practice Address - Fax:617-863-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty