Active NPI
Eline T Luning Prak, MD
- Clinical Pathology/Laboratory Medicine Physician
- Philadelphia, PA
National Provider Identifier
1669415907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Pathology/Laboratory Medicine Physician
- License
- MD066352L
- Practice address
- 51 N 39TH St
Philadelphia, PA 19104-2640 - Phone
- (215) 662-8963
- Fax
- (215) 662-1694
- NPI assigned
- Jun 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Pathology/Laboratory Medicine Physician | 207ZP0105X | MD066352L | PA | Primary |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | MD066352L | PA |
Addresses
Primary practice location
51 N 39TH St
Philadelphia, PA 19104-2640
Mailing address
51 N 39TH St
Philadelphia, PA 19104-2640
Phone (215) 662-8963
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0018027000001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD066352L | PA | MD | Clinical Pathology/Laboratory Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572220800000",
"number": "1669415907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 N 39TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191042640",
"telephone_number": "215-662-8963",
"fax_number": "215-662-1694"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 N 39TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191042640",
"telephone_number": "215-662-8963",
"fax_number": "215-662-1694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNING PRAK",
"first_name": "ELINE",
"middle_name": "T",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-14",
"last_updated": "2019-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0105X",
"taxonomy_group": "",
"desc": "Pathology, Clinical Pathology/Laboratory Medicine",
"state": "PA",
"license": "MD066352L",
"primary": true
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "PA",
"license": "MD066352L",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0018027000001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.