Provider Demographics
NPI:1689629875
Name:LAUTIN, JEFFREY L (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:LAUTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 ROUTE 66
Mailing Address - Street 2:SUITE 131
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7300
Mailing Address - Country:US
Mailing Address - Phone:732-383-4189
Mailing Address - Fax:732-383-4171
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1174
Practice Address - Country:US
Practice Address - Phone:973-243-9729
Practice Address - Fax:973-243-9674
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17646912085R0202X, 2085R0204X
NJ25MA070347002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8163901Medicaid
NJ036736CQHMedicare PIN
NJ036736A2VMedicare PIN
NJ300111040Medicare PIN
G38149Medicare UPIN
NJ8163901Medicaid