Provider Demographics
NPI:1073508933
Name:LATTUGA, SEBASTIAN (MD FACOS)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:
Last Name:LATTUGA
Suffix:
Gender:M
Credentials:MD FACOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:STE 170 W NEW YORK SPECIALISTS LLP
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-355-0111
Mailing Address - Fax:516-355-5457
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:STE 170 W NEW YORK SPECIALISTS LLP
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-355-0111
Practice Address - Fax:516-355-5457
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1870781207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q38923Medicare UPIN
69G421Medicare ID - Type Unspecified