Provider Demographics
NPI:1316957848
Name:HUBBELL, JOHN D (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:HUBBELL
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 1:315 MEETING HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968
Mailing Address - Country:US
Mailing Address - Phone:631-283-0355
Mailing Address - Fax:631-283-2084
Practice Address - Street 1:315 MEETING HOUSE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968
Practice Address - Country:US
Practice Address - Phone:631-283-0355
Practice Address - Fax:631-283-2084
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212726-1207X00000X
NY212726207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02311351Medicaid
NY3R4961Medicare ID - Type Unspecified
NY02311351Medicaid