Provider Demographics
NPI:1649762048
Name:LUSTIG, MARLA GUARIGLIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:GUARIGLIA
Last Name:LUSTIG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:OLDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08858-0305
Mailing Address - Country:US
Mailing Address - Phone:908-439-9636
Mailing Address - Fax:908-439-2338
Practice Address - Street 1:83 OLD TPKE
Practice Address - Street 2:
Practice Address - City:OLDWICK
Practice Address - State:NJ
Practice Address - Zip Code:08858-7001
Practice Address - Country:US
Practice Address - Phone:908-439-9636
Practice Address - Fax:908-439-2338
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00172200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist