Basic Information
| Provider Information | |||||||||
| NPI: | 1023683463 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FL MEDICAL PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 WESTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117436621 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | LYNBROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115631264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163169025 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2021 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | LUBIN | ||||||||
| AuthorizedOfficialFirstName: | FRANTZ | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5163169025 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | NY | MEDICAID |