MEDICARE: STEPHANE S LUBICZ MD

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	207VG0400X	Gynecology Physician	139630	NY
2	207VX0201X	Gynecologic Oncology Physician	139630	NY

General Provider Information

NPI Number	:	1144480427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANE S LUBICZ MD

Provider Business Mailing Address
First Line	:	3777 INDEPENDENCE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-1409
Country	:	US
Telephone Number	:	646-338-9121
Fax Number	:

Provider Business Practice Location Address
First Line	:	3777 INDEPENDENCE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-1409
Country	:	US
Telephone Number	:	646-338-9121
Fax Number	:

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

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	06/11/2008

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