Provider Demographics
NPI:1588600258
Name:LUJBLI, KATHLEEN S (PA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:LUJBLI
Suffix:
Gender:F
Credentials:PA
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 456
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-0456
Mailing Address - Country:US
Mailing Address - Phone:180-024-3585
Mailing Address - Fax:206-824-9510
Practice Address - Street 1:6 CARE LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8624
Practice Address - Country:US
Practice Address - Phone:518-587-7625
Practice Address - Fax:518-587-0723
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5009140363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01915351Medicaid
S72644Medicare UPIN
NY01915351Medicaid