Individual provider Active NPI

Steven H Jutkowitz, DMD

  • Prosthodontics
  • New York, NY
National Provider Identifier
1124262118
Registry record updated Aug 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
045714-1 Issued in NY
Practice address
785 Park Ave
New York, NY 10021-3552
Phone
(212) 535-1218
Fax
(212) 396-2174
NPI assigned
Apr 22, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 045714-1 NY Primary

Addresses

Primary practice location

785 Park Ave
New York, NY 10021-3552

Mailing address

785 Park Ave
New York, NY 10021-3552
Phone (212) 535-1218

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160616000787 NY Order and Referring Only - DentistPractitioner - Dentist 0143511436

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
045714-1NYMDProsthodontist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628121600000",
    "number": "1124262118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "785 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100213552",
            "telephone_number": "212-535-1218",
            "fax_number": "212-396-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100213552",
            "telephone_number": "212-535-1218",
            "fax_number": "212-396-2174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUTKOWITZ",
        "first_name": "STEVEN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-22",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NY",
            "license": "045714-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.