Provider Demographics
NPI:1316957426
Name:LOBO, ROWENA M (MD)
Entity type:Individual
Prefix:DR
First Name:ROWENA
Middle Name:M
Last Name:LOBO
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 1:1080 SUNRISE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701
Mailing Address - Country:US
Mailing Address - Phone:631-854-1006
Mailing Address - Fax:631-854-1031
Practice Address - Street 1:1080 SUNRISE HIGHWAY
Practice Address - Street 2:MAXINE POSTAL TRICOMMUNITY HEALTH
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701
Practice Address - Country:US
Practice Address - Phone:631-854-1006
Practice Address - Fax:631-854-1031
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
U0137461OtherRR
NY01770158Medicaid
RL014G0210Medicare ID - Type Unspecified
NY01770158Medicaid