Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0002X | Hospice and Palliative Medicine | 55718 | CT |
NPI | 1275667560 |
---|---|
Provider Name | Dana Lustbader |
First Address | Manhasset, NY 11030 |
Second Address | Manhasset, NY 11030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 12/09/2016 |