Individual
JESSICA LYNN LASTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
935 NORTHERN BLVD, SUITE 200, GREAT NECK, NY 11021-5309
(516) 829-4414
(516) 829-5286
Mailing address
935 NORTHERN BLVD, SUITE 200, GREAT NECK, NY 11021-5309
(516) 829-4414
(516) 829-5286
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
177033
NY
2085R0202X
Diagnostic Radiology Physician
Primary
177033
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01344283
—
NY
Enumeration date
04/04/2006
Last updated
07/02/2008
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