Healthcare Provider Details

I. General information

NPI: 1780919407
Provider Name (Legal Business Name): DAVID H NEUSTADT PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E GRAY ST SUITE 328
LOUISVILLE KY
40202-1900
US

IV. Provider business mailing address

234 E GRAY ST SUITE 328
LOUISVILLE KY
40202-1900
US

V. Phone/Fax

Practice location:
  • Phone: 502-585-4163
  • Fax: 502-584-7942
Mailing address:
  • Phone: 502-585-4163
  • Fax: 502-584-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: DAVID H NEUSTADT
Title or Position: OWNER
Credential: MD
Phone: 502-585-4163