Basic Information
| Provider Information | |||||||||
| NPI: | 1841215795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUBKIN | ||||||||
| FirstName: | MAXINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSN, ANP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 PORTLAND AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859224136 | ||||||||
| FaxNumber: | 5859225761 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 CARTER ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146212604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859224136 | ||||||||
| FaxNumber: | 5859225761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 11/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F303331 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 303331 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 01131126/RGH | 05 | NY | MEDICAID | P019303331 | 01 | NY | BC/BS OF ROCHESTER PROVID | OTHER | 02699801 | 05 | NY | MEDICAID | G0187459590 | 01 | NY | EXCELLUS/HMO GROUP NUMBER | OTHER | NP0826 | 01 | NY | PREFERRED CARE PROVIDER N | OTHER | P019303331 | 01 | NY | EXCELLUS/HMO PROVIDER NUM | OTHER |