Provider Demographics
NPI:1962406348
Name:LUBITZ, JONATHAN JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAY
Last Name:LUBITZ
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:805 CENTURY MEDICAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2100
Mailing Address - Country:US
Mailing Address - Phone:321-268-6264
Mailing Address - Fax:321-635-9310
Practice Address - Street 1:5005 PORT ST JOHN PKWY
Practice Address - Street 2:SUITE 2100
Practice Address - City:PORT SAINT JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-4305
Practice Address - Country:US
Practice Address - Phone:321-433-2247
Practice Address - Fax:321-635-9310
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2015-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPO1452213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004278200Medicaid
FLFR306ZMedicare UPIN