MEDICARE: ROBERT KEVIN LUNTZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	193877	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55T861	OTHER		BCBS

General Provider Information

NPI Number	:	1609869361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT KEVIN LUNTZ MD

Provider Business Mailing Address
First Line	:	875 OLD COUNTRY RD
Second Line	:	STE 301
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-4942
Country	:	US
Telephone Number	:	516-931-1710
Fax Number	:	516-931-2362

Provider Business Practice Location Address
First Line	:	875 OLD COUNTRY RD
Second Line	:	STE 301
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-4942
Country	:	US
Telephone Number	:	516-931-1710
Fax Number	:	516-931-2362

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	04/14/2011

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