Provider Demographics
NPI:1598849549
Name:USTARIS, LOURDES ABADILLA (MD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:ABADILLA
Last Name:USTARIS
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 1:38 SUSANNA WAY
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-4220
Mailing Address - Country:US
Mailing Address - Phone:215-497-9354
Mailing Address - Fax:
Practice Address - Street 1:SULLIVAN WAY
Practice Address - Street 2:TRENTON PSYCHIATRIC HOSPITAL
Practice Address - City:WEST TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628
Practice Address - Country:US
Practice Address - Phone:609-633-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0631522084P0800X
PAMD056699L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA026394C2DOtherMEDICARE PROVIDER NUMBER
PA026394C2DOtherMEDICARE PROVIDER NUMBER