Basic Information
| Provider Information | |||||||||
| NPI: | 1316957848 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUBBELL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 MEETING HOUSE LN | ||||||||
| Address2: | |||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312830355 | ||||||||
| FaxNumber: | 6312832084 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 MEETING HOUSE | ||||||||
| Address2: | |||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312830355 | ||||||||
| FaxNumber: | 6312832084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 04/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 212726-1 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 212726 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 02311351 | 05 | NY | MEDICAID |