Healthcare Provider Details

I. General information

NPI: 1477171775
Provider Name (Legal Business Name): ADAM HUTTEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 BROADWAY
NEW YORK NY
10034-1609
US

IV. Provider business mailing address

5030 BROADWAY
NEW YORK NY
10034-1609
US

V. Phone/Fax

Practice location:
  • Phone: 516-320-1299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: