Provider Demographics
NPI:1053023457
Name:LUTWYCHE, JARED S
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:S
Last Name:LUTWYCHE
Suffix:
Gender:M
Credentials:
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 640
Mailing Address - Street 2:
Mailing Address - City:CROMPOND
Mailing Address - State:NY
Mailing Address - Zip Code:10517-0640
Mailing Address - Country:US
Mailing Address - Phone:914-382-3340
Mailing Address - Fax:
Practice Address - Street 1:1111 ROUTE 9
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-3237
Practice Address - Country:US
Practice Address - Phone:845-335-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program