MEDICARE: ROBERT LUSTIG DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	175410	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487662698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT LUSTIG DO

Provider Business Mailing Address
First Line	:	1400 PELHAM PKWY S
Second Line	:	BS 32 BUILDING 1
City	:	BRONX
State	:	NY
Zip	:	10461-1138
Country	:	US
Telephone Number	:	718-918-3060
Fax Number	:	718-918-4469

Provider Business Practice Location Address
First Line	:	3424 KOSSUTH AVE
Second Line	:	NORTH CENTRAL BRONX HOSPITAL-PSYCHIATRY-11TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10467-2410
Country	:	US
Telephone Number	:	718-519-3917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	11/26/2014

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