Healthcare Provider Details

I. General information

NPI: 1275667560
Provider Name (Legal Business Name): DANA LUSTBADER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DRIVE NSUH-DEPT OF MED & CRITICAL CARE MED
MANHASSET NY
11030
US

IV. Provider business mailing address

300 COMMUNITY DRIVE NSUH-DEPT OF MED & CRITICAL CARE MEDICINE
MANHASSET NY
11030
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-1621
  • Fax:
Mailing address:
  • Phone: 516-562-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number182494
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number55718
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: