MEDICARE: DR. ERICA ILENE LUBETKIN M.D.

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	207R00000X	Internal Medicine Physician	202031	NY

General Provider Information

NPI Number	:	1073831947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA ILENE LUBETKIN M.D.

Provider Business Mailing Address
First Line	:	160 CONVENT AVE
Second Line	:	H404B
City	:	NEW YORK
State	:	NY
Zip	:	10031-9101
Country	:	US
Telephone Number	:	212-650-7785
Fax Number	:	212-650-7778

Provider Business Practice Location Address
First Line	:	160 CONVENT AVE
Second Line	:	H404B
City	:	NEW YORK
State	:	NY
Zip	:	10031-9101
Country	:	US
Telephone Number	:	212-650-7785
Fax Number	:	212-650-7778

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

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/17/2010

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