MEDICARE: ANNA LUTZ MEDICAL PC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1386340644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNA LUTZ MEDICAL PC

Provider Business Mailing Address
First Line	:	2124 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4933
Country	:	US
Telephone Number	:	917-935-3015
Fax Number	:	718-438-2295

Provider Business Practice Location Address
First Line	:	970 41ST ST STE M1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-1105
Country	:	US
Telephone Number	:	918-935-3015
Fax Number	:	718-438-2295

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANNA LUTZ
Credential	:	MD
Telephone Number	:	917-935-3015

Provider Enumeration Date	:	02/07/2023
Last Update Date	:	02/07/2023

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