Provider Demographics
NPI:1184642787
Name:LUSTIK, STEWART J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:J
Last Name:LUSTIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 604
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5982
Mailing Address - Fax:585-756-0169
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 604
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-5982
Practice Address - Fax:585-756-0169
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY179369207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010179369OtherBLUE CHOICE
NY050029509OtherRAILROAD MEDICARE
NY2222OtherBLUE SHIELD GROUP
NYG0189393590OtherBLUE CHOICE GROUP
NY00372225Medicaid
NY01459347Medicaid
NY4631743OtherAETNA
NY00040213601OtherUNIVERA #
NY000912295001OtherBS WNY/HEALTHNOW
NYMDA552OtherPREFERRED CARE
NY16535AMedicare ID - Type UnspecifiedMEDICARE GROUP