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Individual

CARLOS LASTRA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
254 EASTON AVE, NEW BRUNSWICK, NJ 08901-1766
(732) 339-7870
(732) 745-1632
Mailing address
254 EASTON AVE, NEW BRUNSWICK, NJ 08901-1766

Taxonomy

Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
25MA05442600
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7295804
NJ
Enumeration date
07/19/2006
Last updated
07/08/2007
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