Provider Demographics
NPI:1457394652
Name:LUSTIG, ROBERT H (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:LUSTIG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 US HIGHWAY 202/206 NORTH
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1773
Mailing Address - Country:US
Mailing Address - Phone:908-722-0808
Mailing Address - Fax:908-722-7645
Practice Address - Street 1:766 US HIGHWAY 202/206 NORTH
Practice Address - Street 2:SUITE 1
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1773
Practice Address - Country:US
Practice Address - Phone:908-722-0808
Practice Address - Fax:908-722-7645
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03774500207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0970808Medicaid
NJB34489Medicare UPIN
NJ449418A3MMedicare PIN
NJB34489Medicare UPIN
NJ449418A3MMedicare PIN
NJ0040479OtherAETNA US HEALTHCARE PROV
NJTS043OtherOXFORD PROVIDER #