Provider Demographics
NPI:1053379412
Name:LUTNICK, ROBERT E (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:LUTNICK
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 8000
Mailing Address - Street 2:DEPT 836
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 GENESEE STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-855-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16816412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01131144Medicaid
RB7061OtherMEDICARE
000511685013OtherBLUE SHIELD OF WESTERN NY
000511685017OtherBLUE SHIELD OF WESTERN NY
000525468009OtherBLUE SHIELD OF WESTERN NY
00010107807OtherUNIVERA
145793FFOtherPREFERRED CARE
NY1681642WOtherWORKERS COMPENSATION
P00003639OtherRAILROAD MEDICARE
1608680OtherINDEPENDENT HEALTH
000525468011OtherBLUE SHIELD OF WESTERN NY
040426003026OtherFIDELIS
300127131OtherRAILROAD MEDICARE
000511685017OtherBLUE SHIELD OF WESTERN NY
300127131OtherRAILROAD MEDICARE
040426003026OtherFIDELIS