Healthcare Provider Details

I. General information

NPI: 1649774324
Provider Name (Legal Business Name): JESSICA LEBOWITZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 LEBANON ST
MELROSE MA
02176-3225
US

IV. Provider business mailing address

9 SPRAY AVE
MARBLEHEAD MA
01945-2747
US

V. Phone/Fax

Practice location:
  • Phone: 781-979-3000
  • Fax:
Mailing address:
  • Phone: 978-239-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6487
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: