Organization
TOWN AND COUNTRY PEDIATRICS AND FAMILY MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELINE O LUSTIG D.O. (PRESIDENT)
(860) 274-8891
Entity
Organization
Contact information
Practice address
380 MAIN STREET, WATERTOWN, CT 06795
(860) 274-8891
(860) 274-8895
Mailing address
380 MAIN STREET, WATERTOWN, CT 06795
(860) 274-8891
(860) 274-8895
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
041948
CT
208000000X
Pediatrics Physician
Primary
035903
CT
363LP0200X
Pediatric Nurse Practitioner
001457
CT
Other
Enumeration date
05/09/2007
Last updated
12/12/2012
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