Provider Demographics
NPI:1669585691
Name:LUSTGARTEN, EUGENE JAY (DC)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:JAY
Last Name:LUSTGARTEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 W OAKLAND PARK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1215
Mailing Address - Country:US
Mailing Address - Phone:954-677-8484
Mailing Address - Fax:954-677-8966
Practice Address - Street 1:3075 W OAKLAND PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1215
Practice Address - Country:US
Practice Address - Phone:954-677-8484
Practice Address - Fax:954-677-8966
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT476111N00000X
FLCH4616111N00000X
NYX003820-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4095099Medicaid
CT350000366Medicare ID - Type Unspecified