Provider Demographics
NPI:1205010634
Name:JEFFREY D. LUBELL
Entity Type:Organization
Organization Name:JEFFREY D. LUBELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-731-8052
Mailing Address - Street 1:628 E 222ND ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2032
Mailing Address - Country:US
Mailing Address - Phone:216-731-8052
Mailing Address - Fax:216-731-1855
Practice Address - Street 1:628 E 222ND ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2032
Practice Address - Country:US
Practice Address - Phone:216-731-8052
Practice Address - Fax:216-731-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002220332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0928430001Medicare NSC