Provider Demographics
NPI:1225133895
Name:LOBO, WARREN D (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:D
Last Name:LOBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-0539
Mailing Address - Country:US
Mailing Address - Phone:718-217-2896
Mailing Address - Fax:718-217-4471
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3012
Practice Address - Country:US
Practice Address - Phone:631-321-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175268207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D92254Medicare UPIN
NY08F903Medicare ID - Type Unspecified