Provider Demographics
NPI:1356444160
Name:GIUSTRA, LAUREN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ANN
Last Name:GIUSTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 EAST CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440
Mailing Address - Country:US
Mailing Address - Phone:315-334-9663
Mailing Address - Fax:315-334-1194
Practice Address - Street 1:107 EAST CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-334-9663
Practice Address - Fax:315-334-1194
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202957207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01681323Medicaid
NY01681323Medicaid
NYG30433Medicare UPIN