Provider Demographics
NPI:1407317423
Name:LUBIN, GABRIELLE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:LUBIN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1510
Mailing Address - Country:US
Mailing Address - Phone:516-318-3030
Mailing Address - Fax:516-447-6667
Practice Address - Street 1:312 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1510
Practice Address - Country:US
Practice Address - Phone:516-318-3030
Practice Address - Fax:516-447-6667
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-31
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY746982163W00000X
NYF383750363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse