Provider Demographics
NPI:1740287010
Name:LITUCHY, ANDREW E (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:E
Last Name:LITUCHY
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:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-0415
Mailing Address - Country:US
Mailing Address - Phone:516-365-4888
Mailing Address - Fax:516-365-4820
Practice Address - Street 1:100 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1353
Practice Address - Country:US
Practice Address - Phone:516-365-4888
Practice Address - Fax:516-365-4820
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181585174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01279863Medicaid
NY01279863Medicaid
NYF20962Medicare UPIN