Provider Demographics
NPI:1255596094
Name:ALIMOHAMMAD, LUBBNA V (MD)
Entity type:Individual
Prefix:DR
First Name:LUBBNA
Middle Name:V
Last Name:ALIMOHAMMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LUBBNA
Other - Middle Name:
Other - Last Name:VALLIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:711 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2442
Practice Address - Country:US
Practice Address - Phone:518-783-3110
Practice Address - Fax:518-783-7506
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255012208000000X
VA0101252290208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06193OtherGROUP PTAN
NY03154230Medicaid
NY02995513Medicaid
NY331833Medicare Oscar/Certification
NY02995513Medicaid