Provider Demographics
NPI:1811661325
Name:KUBANICK, GIOVANNI LUCA
Entity type:Individual
Prefix:MR
First Name:GIOVANNI
Middle Name:LUCA
Last Name:KUBANICK
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 1:6 SCOTT CT
Mailing Address - Street 2:
Mailing Address - City:FORT SALONGA
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1460
Mailing Address - Country:US
Mailing Address - Phone:516-376-7898
Mailing Address - Fax:
Practice Address - Street 1:6 SCOTT CT
Practice Address - Street 2:
Practice Address - City:FORT SALONGA
Practice Address - State:NY
Practice Address - Zip Code:11768-1460
Practice Address - Country:US
Practice Address - Phone:516-376-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
5163767898OtherOTHER