Individual
DR. KEITH LUSTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
525 E 68TH ST, F-2132, NEW YORK, NY 10065-4870
(212) 746-5190
Mailing address
1320 YORK AVE, 21P, NEW YORK, NY 10021-4800
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
50-052-454
NY
Other
Enumeration date
06/25/2008
Last updated
06/25/2008
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