MEDICARE: DR. GEORGE J LUBERTAZZO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00354700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X5732	OTHER	NY	EMPIRE BC/BS
2	01095111	OTHER		AMERIGROUP AGP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P634221	OTHER		OXFORD
5	0004369333	OTHER		AETNA

General Provider Information

NPI Number	:	1033251640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE J LUBERTAZZO D.C.

Provider Business Mailing Address
First Line	:	P.O. BOX 1727
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2009
Country	:	US
Telephone Number	:	201-896-0068
Fax Number	:	201-842-1709

Provider Business Practice Location Address
First Line	:	39 MEADOW RD
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2009
Country	:	US
Telephone Number	:	201-896-0068
Fax Number	:	201-842-1709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	01/13/2014

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