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General NPI Number Information
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NPI Number | 1669111969
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Entity Type | Individual
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Provider Name | MATTHIAS LEUTRUM VON ERTINGEN LP
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Gender | Male
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 139 FULTON ST RM 612
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City | NEW YORK
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State | NY
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Zip | 10038-2534
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Country | US
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Telephone | 347-352-1049
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Fax |
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Provider Business Mailing Address
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Address Line | 90 GOLD ST APT 23E
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City | NEW YORK
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State | NY
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Zip | 10038-1843
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Country | US
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Telephone | 917-402-4786
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 001132
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License Number State | NY
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