Provider Demographics
NPI:1871598318
Name:PAUL A. LUSMAN, M.D.P.C.
Entity type:Organization
Organization Name:PAUL A. LUSMAN, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-928-4990
Mailing Address - Street 1:120 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2604
Mailing Address - Country:US
Mailing Address - Phone:631-928-4990
Mailing Address - Fax:631-928-4992
Practice Address - Street 1:120 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2604
Practice Address - Country:US
Practice Address - Phone:631-928-4990
Practice Address - Fax:631-928-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096648174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00393366Medicaid
NYB20183Medicare UPIN
NY00393366Medicaid