Provider Demographics
NPI:1245212281
Name:LYUBLING, EDGAR (MD)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:
Last Name:LYUBLING
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 1:1401 OCEAN AVE
Mailing Address - Street 2:APT 10 - G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3971
Mailing Address - Country:US
Mailing Address - Phone:718-338-5761
Mailing Address - Fax:
Practice Address - Street 1:5801 5 AVE
Practice Address - Street 2:
Practice Address - City:BRKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-439-8787
Practice Address - Fax:718-567-9055
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163084208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00900069Medicaid
NY48D271Medicare ID - Type Unspecified
NY00900069Medicaid