Provider Demographics
NPI:1043255748
Name:LUNDBYE, JUSTIN B (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:B
Last Name:LUNDBYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 GRAND ST
Mailing Address - Street 2:CARDIOLOGY DEPARTMENT
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-2016
Mailing Address - Country:US
Mailing Address - Phone:860-224-5731
Mailing Address - Fax:860-224-5749
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:CARDIOLOGY DEPARTMENT
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052
Practice Address - Country:US
Practice Address - Phone:860-224-5731
Practice Address - Fax:860-224-5749
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT043182207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001431824Medicaid
CTI32249Medicare UPIN
CT060001762 (C00814)Medicare PIN