Provider Demographics
NPI:1326216904
Name:YETTAW LUTS, HOLLY KRISTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:KRISTIN
Last Name:YETTAW LUTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 ROCHAMBEAU AVE
Mailing Address - Street 2:DEPT OF OB/GYN
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2836
Mailing Address - Country:US
Mailing Address - Phone:718-920-5157
Mailing Address - Fax:
Practice Address - Street 1:3332 ROCHAMBEAU AVE
Practice Address - Street 2:DEPT OF OB/GYN
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2836
Practice Address - Country:US
Practice Address - Phone:718-920-5157
Practice Address - Fax:718-920-6313
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301508279207VX0000X
NY2602561207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics