Individual
DR. MICHAEL JAY LUSTICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 ELIZABETH ST, DERBY, CT 06418-1802
(203) 954-0543
Mailing address
30 ELIZABETH ST, DERBY, CT 06418-1802
(203) 954-0543
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
023667
CT
Other
Enumeration date
02/14/2008
Last updated
12/18/2014
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