=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568679686
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOWARD S LUBIN DO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 12/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 EAGLE ROAD
-----------------------------------------------------
City | HAVERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-789-4464
-----------------------------------------------------
Fax | 610-789-7421
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 EAGLE ROAD
-----------------------------------------------------
City | HAVERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-789-4464
-----------------------------------------------------
Fax | 610-789-7421
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. HOWARD S LUBIN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 610-789-4464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | OS000470L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------