1912384488 NPI number — JENNIFER FRANCINE LUTZ DO

Table of content: (NPI 1407885288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912384488 NPI number — JENNIFER FRANCINE LUTZ DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUTZ
Provider First Name:
JENNIFER
Provider Middle Name:
FRANCINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CIFUNI
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
FRANCINE LUTZ
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912384488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4180 BUNKER HILL DR S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOPERSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18036-8814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-314-3026
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 S CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-6202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-402-5846
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  292806 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0203X , with the licence number: OS022042 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)