Active NPI
Elliot Lutz
- General Practice Dentistry
- Fresh Meadows, NY
National Provider Identifier
1376942292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 057524
- Practice address
- 15910 71St Ave Apt 3H
Fresh Meadows, NY 11365-3024 - Phone
- (347) 244-2914
- NPI assigned
- Aug 15, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 057524 | NY | Primary |
Addresses
Primary practice location
15910 71St Ave Apt 3H
Fresh Meadows, NY 11365-3024
Mailing address
15910 71St Ave Apt 3H
Fresh Meadows, NY 11365-3024
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057524 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408060800000",
"number": "1376942292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15910 71ST AVE APT 3H",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113653024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15910 71ST AVE APT 3H",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113653024",
"telephone_number": "347-244-2914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTZ",
"first_name": "ELLIOT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-15",
"last_updated": "2014-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "057524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresh Meadows, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.