Provider Demographics
NPI:1841215795
Name:LUBKIN, MAXINE (MSN, ANP-C)
Entity Type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:
Last Name:LUBKIN
Suffix:
Gender:F
Credentials:MSN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-4136
Mailing Address - Fax:585-922-5761
Practice Address - Street 1:800 CARTER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2604
Practice Address - Country:US
Practice Address - Phone:585-922-4136
Practice Address - Fax:585-922-5761
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303331363LA2200X
NY303331363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01131126/RGHMedicaid
NYP019303331OtherBC/BS OF ROCHESTER PROVID
NY02699801Medicaid
NYG0187459590OtherEXCELLUS/HMO GROUP NUMBER
NYNP0826OtherPREFERRED CARE PROVIDER N
NYP019303331OtherEXCELLUS/HMO PROVIDER NUM
NYP019303331OtherEXCELLUS/HMO PROVIDER NUM
NY02699801Medicaid
NY01131126/RGHMedicaid