Provider Demographics
NPI:1477668283
Name:LUBECK, JOSEPH S (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:LUBECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 BALA PLZ
Mailing Address - Street 2:SUITE IL-9
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1501
Mailing Address - Country:US
Mailing Address - Phone:610-667-0278
Mailing Address - Fax:610-667-4965
Practice Address - Street 1:2 BALA PLZ
Practice Address - Street 2:SUITE IL-9
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1501
Practice Address - Country:US
Practice Address - Phone:610-667-0278
Practice Address - Fax:610-667-4965
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004712L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC30817Medicare UPIN
PA123061Medicare PIN