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General NPI Number Information
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NPI Number | 1063103984
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Entity Type | Organization
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Legal Business Name | LUBIN MEDICAL WELLNESS P.C.
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 4470 BROADWAY FRNT
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City | NEW YORK
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State | NY
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Zip | 10040-2669
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Country | US
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Telephone | 732-789-0801
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Fax |
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Provider Business Mailing Address
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Address Line | 4470 BROADWAY FRNT
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City | NEW YORK
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State | NY
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Zip | 10040-2669
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Country | US
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Telephone | 347-836-5434
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Fax | 347-894-2424
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Authorized Official
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Title or Position | OWNER
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Name | SOPHIA LUBIN
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Credential | DO
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Telephone | 917-805-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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