Provider Demographics
NPI:1841383700
Name:LASHLEY, EUSTACE LAURISTON (MD)
Entity Type:Individual
Prefix:
First Name:EUSTACE
Middle Name:LAURISTON
Last Name:LASHLEY
Suffix:
Gender:M
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:PO BOX 250142
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-0142
Mailing Address - Country:US
Mailing Address - Phone:718-282-0100
Mailing Address - Fax:718-693-8317
Practice Address - Street 1:1847 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5005
Practice Address - Country:US
Practice Address - Phone:718-282-0100
Practice Address - Fax:718-693-8317
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140842207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01091565Medicaid
NY01091565Medicaid
NY25F89Medicare ID - Type Unspecified