Provider Demographics
NPI:1528025178
Name:STUBEUSZ, DEBRA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LYNN
Last Name:STUBEUSZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:227 RIDGE RD
Mailing Address - Street 2:OLV FAMILY CARE CENTER
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1156
Mailing Address - Country:US
Mailing Address - Phone:716-822-5944
Mailing Address - Fax:716-822-3937
Practice Address - Street 1:227 RIDGE RD
Practice Address - Street 2:OLV FAMILY CARE CENTER
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1156
Practice Address - Country:US
Practice Address - Phone:716-822-5499
Practice Address - Fax:716-822-3937
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-12-09
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Provider Licenses
StateLicense IDTaxonomies
NY188738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF75281Medicare UPIN