Provider Demographics
NPI:1477530582
Name:LUTSKY, ERIC N (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:N
Last Name:LUTSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 46TH ST
Mailing Address - Street 2:200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2417
Mailing Address - Country:US
Mailing Address - Phone:212-481-3600
Mailing Address - Fax:212-481-3336
Practice Address - Street 1:20 E 46TH ST
Practice Address - Street 2:200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2417
Practice Address - Country:US
Practice Address - Phone:212-481-3600
Practice Address - Fax:212-481-3336
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01507157Medicaid
F43511Medicare UPIN
NY01507157Medicaid