Healthcare Provider Details

I. General information

NPI: 1710301122
Provider Name (Legal Business Name): ERIN MARIE LUSTIK AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BAUMAN DRIVE SUITE D285
VOORHEES NJ
08043
US

IV. Provider business mailing address

1020 KINGS HIGHWAY NORTH SUITE 201
CHERRY HILL NJ
08034
US

V. Phone/Fax

Practice location:
  • Phone: 856-602-4000
  • Fax: 856-842-5109
Mailing address:
  • Phone: 856-602-4000
  • Fax: 856-842-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00090500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: