Healthcare Provider Details

I. General information

NPI: 1952348351
Provider Name (Legal Business Name): ALAN SCOTT LUBITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S BROADWAY
HICKSVILLE NY
11801-5027
US

IV. Provider business mailing address

560 S BROADWAY
HICKSVILLE NY
11801-5027
US

V. Phone/Fax

Practice location:
  • Phone: 516-937-2237
  • Fax: 516-822-4167
Mailing address:
  • Phone: 516-933-2800
  • Fax: 516-933-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number140032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: