Provider Demographics
NPI:1225225162
Name:ANDREW E LITUCHY, MDPC
Entity Type:Organization
Organization Name:ANDREW E LITUCHY, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:E
Authorized Official - Last Name:LITUCHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-365-4888
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-0415
Mailing Address - Country:US
Mailing Address - Phone:516-365-4888
Mailing Address - Fax:516-365-4820
Practice Address - Street 1:100 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1353
Practice Address - Country:US
Practice Address - Phone:516-365-4888
Practice Address - Fax:516-365-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181585174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01279863Medicaid
NYF20962Medicare UPIN
NY01279863Medicaid