Healthcare Provider Details

I. General information

NPI: 1669797163
Provider Name (Legal Business Name): LUSI HART PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 MIDDLEBUSH RD STE G106
WAPPINGERS FALLS NY
12590-4047
US

IV. Provider business mailing address

66 MIDDLEBUSH RD STE G106
WAPPINGERS FALLS NY
12590-4047
US

V. Phone/Fax

Practice location:
  • Phone: 845-559-3283
  • Fax: 845-218-9222
Mailing address:
  • Phone: 845-559-3283
  • Fax: 845-218-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number009898
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: