Provider Demographics
NPI:1801120670
Name:JONATHAN LOUIS LEBOWITZ MD PC
Entity type:Organization
Organization Name:JONATHAN LOUIS LEBOWITZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:LEBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-424-0101
Mailing Address - Street 1:29 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3345
Mailing Address - Country:US
Mailing Address - Phone:631-424-0101
Mailing Address - Fax:631-424-0165
Practice Address - Street 1:29 GREEN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3345
Practice Address - Country:US
Practice Address - Phone:631-424-0101
Practice Address - Fax:631-424-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152060208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE44812Medicare UPIN
NY240002353Medicare PIN
NY42F501Medicare PIN