=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821142910
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBIN LUSTIG DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 04/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 ARNOT ST SUITE 3
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07644-1629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-472-5433
-----------------------------------------------------
Fax | 973-473-6833
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 ARNOT ST SUITE 3
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07644-1629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-472-5433
-----------------------------------------------------
Fax | 973-473-6833
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | MC03165
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 25MZ00074700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------