Provider Demographics
NPI:1073831947
Name:LUBETKIN, ERICA ILENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:ILENE
Last Name:LUBETKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CONVENT AVE
Mailing Address - Street 2:H404B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-9101
Mailing Address - Country:US
Mailing Address - Phone:212-650-7785
Mailing Address - Fax:212-650-7778
Practice Address - Street 1:160 CONVENT AVE
Practice Address - Street 2:H404B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-9101
Practice Address - Country:US
Practice Address - Phone:212-650-7785
Practice Address - Fax:212-650-7778
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine