Provider Demographics
NPI:1700832417
Name:WILUTIS, ROBERT STEVEN (MS OTR CHT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STEVEN
Last Name:WILUTIS
Suffix:
Gender:M
Credentials:MS OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:70 N COUNTRY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2161
Mailing Address - Country:US
Mailing Address - Phone:631-331-3608
Mailing Address - Fax:631-331-2392
Practice Address - Street 1:70 N COUNTRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2161
Practice Address - Country:US
Practice Address - Phone:631-331-3608
Practice Address - Fax:631-331-2392
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQS4941OtherBCBS
QS9861Medicare ID - Type Unspecified