Provider Demographics
NPI:1659688000
Name:LUBINSKY FETTMAN, TZIPPY (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:TZIPPY
Middle Name:
Last Name:LUBINSKY FETTMAN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5424
Mailing Address - Country:US
Mailing Address - Phone:718-253-2159
Mailing Address - Fax:
Practice Address - Street 1:2094 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5424
Practice Address - Country:US
Practice Address - Phone:718-253-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012674-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist