Provider Demographics
NPI:1154993459
Name:LUTHER, JEAN-LOUIS
Entity type:Individual
Prefix:
First Name:JEAN-LOUIS
Middle Name:
Last Name:LUTHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:OVERLOOK MEDICAL CENTER
Practice Address - Street 2:99 BEAUVOIR AVENUE
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07902-0220
Practice Address - Country:US
Practice Address - Phone:516-945-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14970900367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered