Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 107028 | NY |
NPI | 1003922915 |
---|---|
Provider Name | Dr. Robert Seth Jutkowitz |
First Address | Staten Island, NY 10314 |
Second Address | Staten Island, NY 10314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 27/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B12192 | (02) |