Provider Demographics
NPI:1265060511
Name:LUTA, ALEX DRAGOMIR (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:DRAGOMIR
Last Name:LUTA
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 1:535 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4898
Mailing Address - Country:US
Mailing Address - Phone:212-774-2189
Mailing Address - Fax:212-774-2358
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4898
Practice Address - Country:US
Practice Address - Phone:212-774-2189
Practice Address - Fax:212-774-2358
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328318207R00000X
DCMD210002787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine