Provider Demographics
NPI:1952348351
Name:LUBITZ, ALAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:SCOTT
Last Name:LUBITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5027
Mailing Address - Country:US
Mailing Address - Phone:516-933-2800
Mailing Address - Fax:516-933-2809
Practice Address - Street 1:560 S BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5027
Practice Address - Country:US
Practice Address - Phone:516-937-2237
Practice Address - Fax:516-822-4167
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00894624Medicaid
NY10508889OtherCAQH
NY57A881Medicare ID - Type Unspecified
NY10508889OtherCAQH