Individual
EVAN GABRIEL LUSTBADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
525 E 68TH ST, NEW YORK, NY 10065-4870
(212) 746-6000
Mailing address
525 E 68TH ST, BOX 141, NEW YORK, NY 10065-4870
(212) 746-6000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
280716
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/02/2014
Last updated
12/08/2022
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