Provider Demographics
NPI:1528130705
Name:LUBECK, STANLEY SPENCER (DPM)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:SPENCER
Last Name:LUBECK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WESLEY RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2012
Mailing Address - Country:US
Mailing Address - Phone:610-543-1973
Mailing Address - Fax:
Practice Address - Street 1:501 WESLEY RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2012
Practice Address - Country:US
Practice Address - Phone:610-543-1973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001177L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0074268000OtherBLUE CROSS
LU48276Medicare ID - Type Unspecified
PA0074268000OtherBLUE CROSS