Provider Demographics
NPI:1881612935
Name:AUTZ, ARTHUR (MD DPM)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:AUTZ
Suffix:
Gender:M
Credentials:MD DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 PARK AVENUE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-549-5167
Mailing Address - Fax:631-549-0335
Practice Address - Street 1:775 PARK AVENUE
Practice Address - Street 2:SUITE 330
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-549-5167
Practice Address - Fax:631-549-5167
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3498213E00000X
NY1865181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPOW931Medicare ID - Type Unspecified
NYP36620Medicare PIN
NYG22017Medicare UPIN