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General NPI Number Information
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NPI Number | 1609808443
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Entity Type | Organization
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Legal Business Name | JAY S LEBOW DPM PA
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/21/2010
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Provider Practice Location Address
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Address Line | 1626 E FORT AVE
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City | BALTIMORE
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State | MD
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Zip | 21230-5245
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Country | US
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Telephone | 410-332-1414
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Fax | 410-332-1423
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Provider Business Mailing Address
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Address Line | 1626 E FORT AVE
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City | BALTIMORE
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State | MD
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Zip | 21230-5245
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Country | US
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Telephone | 410-332-1414
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Fax | 410-332-1423
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY S. LEBOW
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Credential | DPM
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Telephone | 410-332-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number |
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License Number State |
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