Provider Demographics
NPI:1295283851
Name:HUBBARD, ERIC ANDREW
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ANDREW
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 ROXBURY RD S
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5230
Mailing Address - Country:US
Mailing Address - Phone:917-399-4650
Mailing Address - Fax:772-365-4650
Practice Address - Street 1:372 ROXBURY RD S
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5230
Practice Address - Country:US
Practice Address - Phone:917-399-4650
Practice Address - Fax:772-365-4650
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant