Healthcare Provider Details

I. General information

NPI: 1982745279
Provider Name (Legal Business Name): GENE JONATHAN LUBOW PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 UNIVERSITY PL 4TH FLOOR
NEW YORK NY
10003-4528
US

IV. Provider business mailing address

11 5TH AVE
NEW YORK NY
10003-4342
US

V. Phone/Fax

Practice location:
  • Phone: 212-677-1871
  • Fax:
Mailing address:
  • Phone: 212-533-1135
  • Fax: 212-533-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014178
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number014178
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number014178
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number014178
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: