Individual
DR. BORIS LUSTIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
239 BOYLE ROAD, STE 7, SELDEN, NY 11784
(631) 698-0600
(631) 698-2212
Mailing address
239 BOYLE ROAD, STE 7, SELDEN, NY 11784
(631) 698-0600
(631) 698-2212
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
108221
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00656877
—
NY
Enumeration date
07/12/2006
Last updated
07/08/2007
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