Provider Demographics
NPI:1548256225
Name:TRUBIANO, PAOLO B (MD)
Entity type:Individual
Prefix:DR
First Name:PAOLO
Middle Name:B
Last Name:TRUBIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 ROUTE 59
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4927
Mailing Address - Country:US
Mailing Address - Phone:845-357-5775
Mailing Address - Fax:845-357-5777
Practice Address - Street 1:255 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4812
Practice Address - Country:US
Practice Address - Phone:845-368-5039
Practice Address - Fax:845-357-5777
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY183486-1207L00000X
NJ25MA08686300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0301477Medicaid
PA1027730430001Medicaid
NYP00412051OtherRAILROAD MEDICARE
NY01543466Medicaid
NJP01043531OtherRAILROAD MEDICARE
PA1027730430001Medicaid
NYF56997Medicare UPIN
NJ224316T7YMedicare PIN