Provider Demographics
NPI:1699749937
Name:LUBANSKY, KENNETH P (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:P
Last Name:LUBANSKY
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 1:2025 HAMBURG TPKE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6260
Mailing Address - Country:US
Mailing Address - Phone:973-839-5070
Mailing Address - Fax:973-839-0084
Practice Address - Street 1:2025 HAMBURG TPKE
Practice Address - Street 2:SUITE D
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6260
Practice Address - Country:US
Practice Address - Phone:973-839-5070
Practice Address - Fax:973-839-0084
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35293207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7726805Medicaid
NJC56522Medicare UPIN
NJ503814MDJMedicare PIN