Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | TD1927 | NJ |
NPI | 1194800011 |
---|---|
Provider Name | Jeffrey Lutsky |
First Address | Watchung, NJ 07069-5471 |
Second Address | Trenton, NJ 08628-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |