Provider Demographics
NPI:1295817369
Name:TRUBISH, DOROTHY L (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:TRUBISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4638
Mailing Address - Country:US
Mailing Address - Phone:716-671-2507
Mailing Address - Fax:716-671-2508
Practice Address - Street 1:3030 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4638
Practice Address - Country:US
Practice Address - Phone:716-671-2507
Practice Address - Fax:716-671-2508
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG02057Medicare UPIN
NYCC5590Medicare ID - Type Unspecified