Healthcare Provider Details

I. General information

NPI: 1588600258
Provider Name (Legal Business Name): KATHLEEN S LUJBLI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CARE LN
SARATOGA SPRINGS NY
12866-8624
US

IV. Provider business mailing address

PO BOX 456
ALBANY NY
12201-0456
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-7625
  • Fax: 518-587-0723
Mailing address:
  • Phone: 180-024-3585
  • Fax: 206-824-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5009140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: