=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427002393
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD S LUBETSKY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2006
-----------------------------------------------------
Last Update Date | 08/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1380 NE MIAMI GARDENS DR SUITE 280
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33179-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-274-8080
-----------------------------------------------------
Fax | 786-274-8949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3131 NE 210TH TER
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-3669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-274-8080
-----------------------------------------------------
Fax | 786-274-8949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME74933
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0074933
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------