Provider Demographics
NPI:1710301122
Name:LUSTIK, ERIN MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:LUSTIK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 KINGS HIGHWAY NORTH
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034
Mailing Address - Country:US
Mailing Address - Phone:856-602-4000
Mailing Address - Fax:856-842-5109
Practice Address - Street 1:200 BAUMAN DRIVE
Practice Address - Street 2:SUITE D285
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-602-4000
Practice Address - Fax:856-842-5109
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00090500231H00000X
FLAY1830231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist