Provider Demographics
NPI:1033251640
Name:LUBERTAZZO, GEORGE J (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:LUBERTAZZO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1727
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2009
Mailing Address - Country:US
Mailing Address - Phone:201-896-0068
Mailing Address - Fax:201-842-1709
Practice Address - Street 1:39 MEADOW RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2009
Practice Address - Country:US
Practice Address - Phone:201-896-0068
Practice Address - Fax:201-842-1709
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00354700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5732OtherEMPIRE BC/BS
01095111OtherAMERIGROUP AGP
NJ1088009Medicaid
P634221OtherOXFORD
0004369333OtherAETNA
NYX5732OtherEMPIRE BC/BS
NJ1088009Medicaid