1083707368 NPI number — HELEN B LUTZ RN, LMT

Table of content: HELEN B LUTZ RN, LMT (NPI 1083707368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083707368 NPI number — HELEN B LUTZ RN, LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUTZ
Provider First Name:
HELEN
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083707368
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 MELWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14626-4277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-733-1971
Provider Business Mailing Address Fax Number:
440-848-1878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3380 MONROE AVE
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618-4726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-733-1971
Provider Business Practice Location Address Fax Number:
440-848-1878
Provider Enumeration Date:
10/01/2006

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: 225700000X , with the licence number:  013085-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1107599 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MNY308B . This is a "LANDMARK HEALTHCARE, INC., MVP HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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