Provider Demographics
NPI:1780919407
Name:DAVID H NEUSTADT PSC
Entity type:Organization
Organization Name:DAVID H NEUSTADT PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:NEUSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-585-4163
Mailing Address - Street 1:234 E GRAY ST
Mailing Address - Street 2:SUITE 328
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1900
Mailing Address - Country:US
Mailing Address - Phone:502-585-4163
Mailing Address - Fax:502-584-7942
Practice Address - Street 1:234 E GRAY ST
Practice Address - Street 2:SUITE 328
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1900
Practice Address - Country:US
Practice Address - Phone:502-585-4163
Practice Address - Fax:502-584-7942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64109317Medicaid
000000062584OtherANTHEM BCBS
KY1059201Medicare PIN