Organization
DR. LUSTGARTEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE JAY LUSTGARTEN DC (OWNER)
(203) 245-8217
Entity
Organization
Contact information
Practice address
15 MEIGS AVE, MADISON, CT 06443-3057
(203) 245-8217
Mailing address
15 MEIGS AVE, MADISON, CT 06443-3057
(203) 245-8217
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
476
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004095099
—
CT
Enumeration date
04/03/2008
Last updated
04/03/2008
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