Basic Information
| Provider Information | |||||||||
| NPI: | 1700832417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILUTIS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS OTR CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 N COUNTRY RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117772161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313313608 | ||||||||
| FaxNumber: | 6313312392 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 N COUNTRY RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117772161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313313608 | ||||||||
| FaxNumber: | 6313312392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 10/31/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 008737 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | QS4941 | 01 | NY | BCBS | OTHER |