Provider Demographics
NPI:1306894621
Name:TRIMBA, LYUDMILA (MD)
Entity type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:TRIMBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MAYFAIR DR S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6930
Mailing Address - Country:US
Mailing Address - Phone:646-250-2180
Mailing Address - Fax:
Practice Address - Street 1:71 5TH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7306
Practice Address - Country:US
Practice Address - Phone:631-665-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225644208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02544461Medicaid
NY0507J1Medicare ID - Type Unspecified
NY02544461Medicaid