Provider Demographics
NPI:1659484129
Name:HUNTINGTON BAY OBSTETRICS & GYNECOLOGY, P.C.
Entity type:Organization
Organization Name:HUNTINGTON BAY OBSTETRICS & GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LUSTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-421-4100
Mailing Address - Street 1:110 EAST MAIN STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-421-4100
Mailing Address - Fax:631-421-5336
Practice Address - Street 1:110 EAST MAIN STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-421-4100
Practice Address - Fax:631-421-5336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182725207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F63867Medicare UPIN
78H021Medicare ID - Type Unspecified