Basic Information
| Provider Information | |||||||||
| NPI: | 1326216904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YETTAW LUTS | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | KRISTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3332 ROCHAMBEAU AVE | ||||||||
| Address2: | DEPT OF OB/GYN | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189205157 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3332 ROCHAMBEAU AVE | ||||||||
| Address2: | DEPT OF OB/GYN | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189205157 | ||||||||
| FaxNumber: | 7189206313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2008 | ||||||||
| LastUpdateDate: | 08/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2602561 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.