Provider Demographics
NPI:1932149788
Name:RONALD S LUBETSKY MD
Entity Type:Organization
Organization Name:RONALD S LUBETSKY MD
Other - Org Name:ER URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMBERELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-831-0103
Mailing Address - Street 1:193 FOX HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18648 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2406
Practice Address - Country:US
Practice Address - Phone:305-622-3434
Practice Address - Fax:305-622-9429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5895744332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
1015836OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1015836OtherOTHER ID NUMBER