Provider Demographics
NPI:1396718383
Name:HUBICKI, WALTER W II (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:W
Last Name:HUBICKI
Suffix:II
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:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12083-0098
Mailing Address - Country:US
Mailing Address - Phone:518-966-4433
Mailing Address - Fax:518-966-4728
Practice Address - Street 1:77 COUNTY ROUTE 26A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12083-3921
Practice Address - Country:US
Practice Address - Phone:518-966-4433
Practice Address - Fax:518-966-4728
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02506687Medicaid
NYI01396Medicare UPIN
NY02506687Medicaid