=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801860812
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN JOSPEH LEBOWITZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2006
-----------------------------------------------------
Last Update Date | 06/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 PATERSON ST SUITE 2100, 2ND FLOOR, KIDNEY TRANSPLANT
-----------------------------------------------------
City | NEW BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08901-1962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-235-8871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 ROBERT WOOD JOHNSON PL RENAL DIVISION, 4TH FLOOR MEB
-----------------------------------------------------
City | NEW BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08901-1928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-235-4453
-----------------------------------------------------
Fax | 732-235-6124
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD063327L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 25MA08315700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------