Healthcare Provider Details

I. General information

NPI: 1932149788
Provider Name (Legal Business Name): RONALD S LUBETSKY MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18648 NW 67TH AVE
HIALEAH FL
33015-2406
US

IV. Provider business mailing address

193 FOX HOLLOW RD
WYCKOFF NJ
07481-2514
US

V. Phone/Fax

Practice location:
  • Phone: 305-622-3434
  • Fax: 305-622-9429
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number5895744
License Number StateFL

VIII. Authorized Official

Name: PAUL TAMBERELLI
Title or Position: PRESIDENT
Credential:
Phone: 201-831-0103