Provider Demographics
NPI:1659706570
Name:TRUBETSKY, LYUDMILA (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:LYUDMILA
Middle Name:
Last Name:TRUBETSKY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2942 W 5TH ST
Mailing Address - Street 2:APT. 7T
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3834
Mailing Address - Country:US
Mailing Address - Phone:646-546-3045
Mailing Address - Fax:718-946-0522
Practice Address - Street 1:2942 W 5TH ST
Practice Address - Street 2:APT. 7T
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3834
Practice Address - Country:US
Practice Address - Phone:646-546-3045
Practice Address - Fax:718-946-0522
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009180363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical