Provider Demographics
NPI:1851411938
Name:JEFFREY L LEBOW DO PA
Entity Type:Organization
Organization Name:JEFFREY L LEBOW DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-947-3700
Mailing Address - Street 1:3435 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4426
Mailing Address - Country:US
Mailing Address - Phone:305-947-3700
Mailing Address - Fax:954-947-9610
Practice Address - Street 1:3435 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4426
Practice Address - Country:US
Practice Address - Phone:305-947-3700
Practice Address - Fax:954-747-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9533Medicare ID - Type Unspecified