Provider Demographics
NPI:1619051026
Name:KUTZY, THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:KUTZY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 DEHAVEN DR
Mailing Address - Street 2:UNIT 133
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1349
Mailing Address - Country:US
Mailing Address - Phone:914-613-8784
Mailing Address - Fax:
Practice Address - Street 1:119 DEHAVEN DR
Practice Address - Street 2:UNIT 133
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1349
Practice Address - Country:US
Practice Address - Phone:914-613-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234789207R00000X
CT57200207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine