MEDICARE: LYUDMILA KUBYNINA

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	156FX1800X	Optician	008251-1	NY

General Provider Information

NPI Number	:	1992895932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYUDMILA KUBYNINA

Provider Business Mailing Address
First Line	:	50 DORTMUNDER DR
Second Line	:
City	:	MANALAPAN
State	:	NJ
Zip	:	07726-3800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2015
Country	:	US
Telephone Number	:	718-420-6191
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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Directions to “ LYUDMILA KUBYNINA ” Practice Location

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