Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X0100861 | NY |
N | 111NI0013X | Independent Medical Examiner | X-010086-1 | NY |
NPI | 1639268865 |
---|---|
Provider Name | Mr. Robert Edward Lutz JR. |
First Address | Plainview, NY 11803 |
Second Address | Plainview, NY 11803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 24/11/2008 |