Basic Information
| Provider Information | |||||||||
| NPI: | 1962548438 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERRUTTI | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1152 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117430656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163985190 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 N PLANDOME RD | ||||||||
| Address2: | |||||||||
| City: | PORT WASHINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110503443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169443882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 10/13/2010 | ||||||||
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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 | 207ZD0900X | 200021-1 | NY | Y | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
No ID Information.