Provider Demographics
NPI:1649271057
Name:BRUSTMAN, LOIS EILEEN (MD)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:EILEEN
Last Name:BRUSTMAN
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:PO BOX 95000-4930
Mailing Address - Street 2:PERINATAL ASSOCIATES OF SLR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-4930
Mailing Address - Country:US
Mailing Address - Phone:516-338-5300
Mailing Address - Fax:516-333-1075
Practice Address - Street 1:1000 10TH AVE STE 11A
Practice Address - Street 2:PERINATAL ASSOCIATES OF SLR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-8110
Practice Address - Fax:212-523-3472
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY149044-1207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10457394OtherCAQH ID
NY149044-1OtherNYS LICENSE
NY01042066Medicaid
BB4830419OtherDEA
10457394OtherCAQH ID
NY22D933Medicare ID - Type Unspecified
NY01042066Medicaid