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General NPI Number Information
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NPI Number | 1326216904
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Entity Type | Individual
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Provider Name | HOLLY KRISTIN YETTAW LUTS MD
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Gender | Female
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 3332 ROCHAMBEAU AVE DEPT OF OB/GYN
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City | BRONX
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State | NY
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Zip | 10467-2836
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Country | US
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Telephone | 718-920-5157
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Fax | 718-920-6313
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Provider Business Mailing Address
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Address Line | 3332 ROCHAMBEAU AVE DEPT OF OB/GYN
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City | BRONX
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State | NY
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Zip | 10467-2836
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Country | US
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Telephone | 718-920-5157
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 4301508279
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2602561
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License Number State | NY
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