Provider Demographics
NPI:1912266974
Name:WOROCH, LUBOSLAV (DO)
Entity Type:Individual
Prefix:DR
First Name:LUBOSLAV
Middle Name:
Last Name:WOROCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8460
Mailing Address - Country:US
Mailing Address - Phone:631-444-5400
Mailing Address - Fax:631-444-7538
Practice Address - Street 1:100 NICHOLS ROAD
Practice Address - Street 2:HSC L4 RM 120
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8460
Practice Address - Country:US
Practice Address - Phone:631-444-5400
Practice Address - Fax:631-444-7538
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2738342085R0202X
FLOS 120432085R0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program