MEDICARE: RACHEL LUSTGARTEN

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1538312707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LUSTGARTEN

Provider Business Mailing Address
First Line	:	575 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-6102
Country	:	US
Telephone Number	:	212-590-5715
Fax Number	:	212-590-5798

Provider Business Practice Location Address
First Line	:	1165 YORK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7917
Country	:	US
Telephone Number	:	646-962-2111
Fax Number	:	646-962-0159

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

Provider Enumeration Date	:	10/31/2008
Last Update Date	:	05/29/2015

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Directions to “ RACHEL LUSTGARTEN ” Practice Location

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