MEDICARE: JEFFREY D. LUBELL

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	332B00000X	Durable Medical Equipment & Medical Supplies	36-002220	OH

General Provider Information

NPI Number	:	1205010634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY D. LUBELL

Provider Business Mailing Address
First Line	:	628 E 222ND ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2032
Country	:	US
Telephone Number	:	216-731-8052
Fax Number	:	216-731-1855

Provider Business Practice Location Address
First Line	:	628 E 222ND ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2032
Country	:	US
Telephone Number	:	216-731-8052
Fax Number	:	216-731-1855

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY D LUBELL
Credential	:	D.P.M.
Telephone Number	:	216-731-8052

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	01/25/2013

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