Provider Demographics
NPI:1225881006
Name:LUSCH, THOMAS (PEER SPECIALIST)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:LUSCH
Suffix:
Gender:M
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 JEROME PL
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-8908
Mailing Address - Country:US
Mailing Address - Phone:732-853-7168
Mailing Address - Fax:
Practice Address - Street 1:540 BORDENTOWN AVE STE 203
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1546
Practice Address - Country:US
Practice Address - Phone:732-963-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00232300175T00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No175T00000XOther Service ProvidersPeer Specialist