Provider Demographics
NPI:1962548438
Name:BERRUTTI, LUIS E (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:E
Last Name:BERRUTTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1152
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-0656
Mailing Address - Country:US
Mailing Address - Phone:516-398-5190
Mailing Address - Fax:
Practice Address - Street 1:2 N PLANDOME RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3443
Practice Address - Country:US
Practice Address - Phone:516-944-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200021-1207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology