Michael Jay Lustick, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

023667 Issued in CT

Practice address

30 Elizabeth St
Derby, CT 06418-1802

Phone

(203) 954-0543

NPI assigned

Feb 14, 2008

Last updated

Dec 18, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418860800000",
    "number": "1699943589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 ELIZABETH ST",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181802",
            "telephone_number": "203-954-0543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 ELIZABETH ST",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181802",
            "telephone_number": "203-954-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUSTICK",
        "first_name": "MICHAEL",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-14",
        "last_updated": "2014-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CT",
            "license": "023667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Claire A Lukas, CRNA
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• M&S Eyecare
• Erica Grace Macero
• David Maffei, PA
• Raruenjit Majarone, RPT

• Child & Adolescent Psychiatry Physician in Derby, CT
• Providers in Derby, CT by specialty
• Child & Adolescent Psychiatry Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.