Healthcare Provider Details

I. General information

NPI: 1033251640
Provider Name (Legal Business Name): GEORGE J LUBERTAZZO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 MEADOW RD
RUTHERFORD NJ
07070-2009
US

IV. Provider business mailing address

P.O. BOX 1727
RUTHERFORD NJ
07070-2009
US

V. Phone/Fax

Practice location:
  • Phone: 201-896-0068
  • Fax: 201-842-1709
Mailing address:
  • Phone: 201-896-0068
  • Fax: 201-842-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00354700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: