OrganizationActive
Lsa
NPI 1790145852 · Exclusive Provider Organization · Brooklyn, NY
Provider details
- NPI number
- 1790145852
- Entity type
- Organization
- Primary specialty
- Exclusive Provider OrganizationManaged Care Organizations
- Organization subpart
- No
- Authorized official
- Ertuana Jorges, Director(973) 342-9106
- License
- 261QR0401X (NY)
Specialties & taxonomies
Managed Care Organizations
Practice location
1300 Avenue P
Brooklyn, NY 11229-1106
Phone: (718) 645-9183
Approximate (ZIP-level) locationGet directions
Mailing address
1300 Avenue P
Brooklyn, NY 11229-1106
Registry dates
- Enumerated
- 2016-03-02
- Last updated
- 2016-03-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.