Provider Demographics
NPI:1003922915
Name:JUTKOWITZ, ROBERT SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SETH
Last Name:JUTKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:78 TODT HILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-442-7133
Mailing Address - Fax:718-442-6970
Practice Address - Street 1:78 TODT HILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-442-7133
Practice Address - Fax:718-442-6970
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1070282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12192Medicare UPIN
NY281941Medicare PIN