Provider Demographics
NPI:1063418994
Name:LEBOWITZ, NATHANIEL E (MD)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:E
Last Name:LEBOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5005
Mailing Address - Country:US
Mailing Address - Phone:201-461-6200
Mailing Address - Fax:201-461-7204
Practice Address - Street 1:2200 FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5005
Practice Address - Country:US
Practice Address - Phone:201-461-6200
Practice Address - Fax:201-461-7204
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06725600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2620901Medicaid
NJG80734Medicare UPIN
NJ019674C3ZMedicare PIN