Provider Demographics
NPI:1245239615
Name:LOBIANCO, JOSEPH SEBASTIAN (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SEBASTIAN
Last Name:LOBIANCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2926
Mailing Address - Country:US
Mailing Address - Phone:631-361-5445
Mailing Address - Fax:631-361-9163
Practice Address - Street 1:8 RAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2926
Practice Address - Country:US
Practice Address - Phone:631-361-5445
Practice Address - Fax:631-361-9163
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0053891213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP95682Medicare ID - Type Unspecified
U67559Medicare UPIN