MEDICARE: GABRIELLE LUBIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	746982	NY
2	363LP0200X	Pediatric Nurse Practitioner	F383750	NY

General Provider Information

NPI Number	:	1407317423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE LUBIN

Provider Business Mailing Address
First Line	:	STONY BROOK CHILDREN'S HOSPITAL
Second Line	:	PEDIATRIC HEMATOLOGY/ONCOLOGY
City	:	STONY BROOK
State	:	NY
Zip	:	11794-0001
Country	:	US
Telephone Number	:	631-444-7720
Fax Number	:	631-444-8968

Provider Business Practice Location Address
First Line	:	101 NICOLLS RD
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-0001
Country	:	US
Telephone Number	:	631-444-7720
Fax Number	:	631-444-7865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2019
Last Update Date	:	02/06/2026

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