Healthcare Provider Details

I. General information

NPI: 1790362234
Provider Name (Legal Business Name): ERIC LUBOMIR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 BAY PKWY STE 603
BROOKLYN NY
11204-6080
US

IV. Provider business mailing address

701 N BROADWAY STE 405
SLEEPY HOLLOW NY
10591-1020
US

V. Phone/Fax

Practice location:
  • Phone: 718-576-2001
  • Fax:
Mailing address:
  • Phone: 914-366-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number331319
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: