Provider Demographics
NPI:1487662698
Name:LUSTIG, ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LUSTIG
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1400 PELHAM PKWY S
Mailing Address - Street 2:BS 32 BUILDING 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1138
Mailing Address - Country:US
Mailing Address - Phone:718-918-3060
Mailing Address - Fax:718-918-4469
Practice Address - Street 1:3424 KOSSUTH AVE
Practice Address - Street 2:NORTH CENTRAL BRONX HOSPITAL-PSYCHIATRY-11TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2410
Practice Address - Country:US
Practice Address - Phone:718-519-3917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1754102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01989748Medicaid
NY01989748Medicaid
ME88K731Medicare ID - Type UnspecifiedMEDICARE NUMBER