Provider Demographics
NPI:1962531038
Name:SLUPSKY, LYUDMILA M (MD)
Entity type:Individual
Prefix:DR
First Name:LYUDMILA
Middle Name:M
Last Name:SLUPSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 E 14TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3966
Mailing Address - Country:US
Mailing Address - Phone:718-615-9000
Mailing Address - Fax:
Practice Address - Street 1:2626 E 14TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3966
Practice Address - Country:US
Practice Address - Phone:718-615-9000
Practice Address - Fax:718-934-5954
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01925653Medicaid
NY48C891Medicare ID - Type Unspecified
NY01925653Medicaid