Healthcare Provider Details

I. General information

NPI: 1205010634
Provider Name (Legal Business Name): JEFFREY D. LUBELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 E 222ND ST
EUCLID OH
44123-2032
US

IV. Provider business mailing address

628 E 222ND ST
EUCLID OH
44123-2032
US

V. Phone/Fax

Practice location:
  • Phone: 216-731-8052
  • Fax: 216-731-1855
Mailing address:
  • Phone: 216-731-8052
  • Fax: 216-731-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number36-002220
License Number StateOH

VIII. Authorized Official

Name: DR. JEFFREY D LUBELL
Title or Position: OWNER
Credential: D.P.M.
Phone: 216-731-8052