Provider Demographics
NPI:1952824724
Name:KUBANIK, JOSEPH M (DR)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:KUBANIK
Suffix:
Gender:M
Credentials:DR
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:M
Other - Last Name:KUBANIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DR
Mailing Address - Street 1:4201 SOUTHERNLY POINTE DR
Mailing Address - Street 2:4201
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927
Mailing Address - Country:US
Mailing Address - Phone:845-598-4990
Mailing Address - Fax:
Practice Address - Street 1:4201 SOUTHERNLY POINTE DR
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-2137
Practice Address - Country:US
Practice Address - Phone:845-598-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist