Provider Demographics
NPI:1427297456
Name:LUSTIG, MARNIE (MD)
Entity type:Individual
Prefix:DR
First Name:MARNIE
Middle Name:
Last Name:LUSTIG
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 1:39 WESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:445 BROADHOLLOW RD
Practice Address - Street 2:SUITE 25
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3669
Practice Address - Country:US
Practice Address - Phone:516-474-1201
Practice Address - Fax:516-224-4346
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-15
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1787572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF62456Medicare UPIN