Provider Demographics
NPI:1043497837
Name:DR FREDERICK LUBELL, DPM
Entity Type:Organization
Organization Name:DR FREDERICK LUBELL, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-826-6040
Mailing Address - Street 1:2428 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5704
Mailing Address - Country:US
Mailing Address - Phone:516-826-6040
Mailing Address - Fax:516-826-5821
Practice Address - Street 1:2428 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5704
Practice Address - Country:US
Practice Address - Phone:516-826-6040
Practice Address - Fax:516-826-5821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDERICK LUBELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-24
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
5103190001Medicare NSC
NYP14732Medicare PIN