Provider Demographics
NPI:1508926163
Name:WALETZKY, LUCY (MD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:WALETZKY
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 1:239 N BROADWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-2674
Mailing Address - Country:US
Mailing Address - Phone:914-366-6100
Mailing Address - Fax:
Practice Address - Street 1:239 N BROADWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2674
Practice Address - Country:US
Practice Address - Phone:914-366-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104021-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05I851Medicare ID - Type UnspecifiedMEDICARE
NYB94024Medicare UPIN