NPIMap

Organization Active NPI

Lumina Dr G Medical PLLC

  • Internal Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1407664469
Registry record updated Dec 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LUMINA DR G MEDICAL PLLC
Practice address
8120 15TH Ave
Brooklyn, NY 11228-3120
Phone
(718) 331-2897
NPI assigned
Dec 23, 2024
Last updated
Dec 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Victor J GuadagninoNPI 1215939038
Title
Medical Director
Phone
(516) 817-7093

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

8120 15TH Ave
Brooklyn, NY 11228-3120

Mailing address

15 Lord Ave Ste 1
Lawrence, NY 11559-1321
Phone (516) 817-7093

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ, WV, FL, NH, ME, NM, VA8 enrollments

Enrollment records 8

Enrollment IDStateProvider typePAC IDDetails
O20250114003144 PA Part B Supplier - Clinic/Group Practice 4183152457 Receives reassigned benefits from 13 practitioners
Practice locations: Lancaster, PA
O20250128002793 NJ Part B Supplier - Clinic/Group Practice 4183152457 Receives reassigned benefits from 5 practitioners
Practice locations: Cedar Grove, NJ
O20250310000884 WV Part B Supplier - Clinic/Group Practice 4183152457 Receives reassigned benefits from 3 practitioners
Practice locations: Hurricane, WV
O20250318002742 FL Part B Supplier - Clinic/Group Practice 4183152457 Receives reassigned benefits from 13 practitioners
Practice locations: Miami, FL
O20250408002114 NH Part B Supplier - Clinic/Group Practice 4183152457 Receives reassigned benefits from 4 practitioners
Practice locations: Concord, NH
O20260422003234 ME Part B Supplier - Clinic/Group Practice 4183152457 Receives reassigned benefits from 2 practitioners
Practice locations: Westbrook, ME
O20260529000308 NM Part B Supplier - Clinic/Group Practice 4183152457 Receives reassigned benefits from 3 practitioners
Practice locations: Albuquerque, NM
O20260602001823 VA Part B Supplier - Clinic/Group Practice 4183152457 Receives reassigned benefits from 4 practitioners
Practice locations: Fredericksburg, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734912000000",
    "number": "1407664469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LORD AVE STE 1",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115591321",
            "telephone_number": "516-817-7093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8120 15TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112283120",
            "telephone_number": "718-331-2897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMINA DR G MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-23",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A",
        "authorized_official_last_name": "GUADAGNINO",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "516-817-7093"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.