Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 21022 | MA |
N | 2081P2900X | Pain Medicine | 21022 | MA |
N | 2081S0010X | Sports Medicine | 21022 | MA |
N | 213ES0000X | Sports Medicine | 21022 | MA |
Y | 225100000X | Physical Therapist | 21022 | MA |
NPI | 1366086407 |
---|---|
Provider Name | Noa Lustgarten |
First Address | Brookline, MA 02446-3202 |
Second Address | Brookline, MA 02446-3202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2019 |
Last Update Date | 01/11/2019 |