Erin N Lustbader | Staten Island, NY • PECOS Search

Erin N Lustbader

Speech-Language Pathologist

Speech, Language and Hearing Service Providers

1110 South Ave Ste 405, Staten Island, NY 10314-3414

(718) 556-1616 (973) 494-1396

PECOS Enrollment

Based on the most recent information from CMS, provider Erin N Lustbader does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1407403132
Provider Type
Individual
Full Name
Lustbader, Erin N
Title
Miss
Credential
MS, TSSLD, CCC-SLP

Gender
Female
Sole Proprietor
Yes
Enumeration Date
8/19/2019
Last Updated
8/19/2019

Contact Information

Practice Location

1110 South Ave Ste 405, Staten Island, NY 10314-3414

Unlisted Fax

Mailing Location

115 E 34th St Apt 20g, New York, NY 10016-4631

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 235Z00000X Primary	Description Speech-Language Pathologist Speech, Language and Hearing Service Providers	License Unlisted Issuer New York