Provider Demographics
NPI:1801860812
Name:LEBOWITZ, JONATHAN JOSPEH (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JOSPEH
Last Name:LEBOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROBERT WOOD JOHNSON PL
Mailing Address - Street 2:RENAL DIVISION, 4TH FLOOR MEB
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1928
Mailing Address - Country:US
Mailing Address - Phone:732-235-4453
Mailing Address - Fax:732-235-6124
Practice Address - Street 1:125 PATERSON ST
Practice Address - Street 2:SUITE 2100, 2ND FLOOR, KIDNEY TRANSPLANT
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063327L174400000X
NJ25MA08315700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8661502Medicaid
NJP00700401OtherRAILROAD MEDICARE PTAN
PAH20773Medicare UPIN
NJ136193A4EMedicare PIN
PA039867DYLMedicare ID - Type Unspecified