Provider Demographics
NPI:1922466846
Name:PARK-LUSTERMAN, HANNAH (CNA, HHA, PCA)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:PARK-LUSTERMAN
Suffix:
Gender:F
Credentials:CNA, HHA, PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 HASTINGS ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4534
Mailing Address - Country:US
Mailing Address - Phone:516-428-1183
Mailing Address - Fax:
Practice Address - Street 1:777 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4534
Practice Address - Country:US
Practice Address - Phone:516-428-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343488061013E374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide