Provider Demographics
NPI:1598919326
Name:LUNDSTEDT, JUSTIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:LUNDSTEDT
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 NINHAM AVE
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6024
Mailing Address - Country:US
Mailing Address - Phone:845-226-4525
Mailing Address - Fax:
Practice Address - Street 1:58 NINHAM AVE
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6024
Practice Address - Country:US
Practice Address - Phone:845-226-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010207174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist