Provider Demographics
NPI:1689721854
Name:LUSTIG, ILANA DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ILANA
Middle Name:DENISE
Last Name:LUSTIG
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 1:233A E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6302
Mailing Address - Country:US
Mailing Address - Phone:212-696-9536
Mailing Address - Fax:212-532-8020
Practice Address - Street 1:233A E 31ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6302
Practice Address - Country:US
Practice Address - Phone:212-696-9536
Practice Address - Fax:212-532-8020
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146089207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNP1230OtherOXFORD
NYNP1230OtherOXFORD
NY98A501Medicare ID - Type Unspecified