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General NPI Number Information
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NPI Number | 1992666283
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Entity Type | Organization
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Legal Business Name | DAVID LUTZ PHYSICIAN ASSISTANT PLLC
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Dates
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Enumeration Date | 11/18/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 945 BROADWAY
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City | WOODMERE
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State | NY
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Zip | 11598
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Country | US
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Telephone | 347-446-1999
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Fax | 623-374-4592
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Provider Business Mailing Address
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Address Line | 3650 LONG BEACH RD # 1009
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City | OCEANSIDE
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State | NY
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Zip | 11572-5705
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Country | US
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Telephone | 347-446-1999
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Fax | 623-374-4592
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Authorized Official
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Title or Position | OWNER
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Name | DAVID LUTZ
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Credential | PA
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Telephone | 347-446-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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