Provider Demographics
NPI:1679834584
Name:LUTWICK, CHRISTINE O (MSED)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:O
Last Name:LUTWICK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 LINDALE ST
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2309
Mailing Address - Country:US
Mailing Address - Phone:516-996-2347
Mailing Address - Fax:
Practice Address - Street 1:2970 LINDALE ST
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2309
Practice Address - Country:US
Practice Address - Phone:516-996-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2013832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist