MEDICARE: DR. MICHELINE O LOUBEAU 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	282N00000X	General Acute Care Hospital	132325	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	132325	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1154473072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELINE O LOUBEAU M.D.

Provider Business Mailing Address
First Line	:	45 RUGBY RD
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-3924
Country	:	US
Telephone Number	:	914-636-4478
Fax Number	:	718-579-4860

Provider Business Practice Location Address
First Line	:	234 E 149TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5504
Country	:	US
Telephone Number	:	718-579-5898
Fax Number	:	718-579-4860

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	12/21/2025

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