Provider Demographics
NPI:1962409953
Name:LEBOWITZ, DANIEL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
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 1:3820 NORTHDALE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1893
Mailing Address - Country:US
Mailing Address - Phone:813-867-0606
Mailing Address - Fax:813-434-2023
Practice Address - Street 1:1900 GLADES RD STE 100
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7333
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:888-812-8191
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162079202K00000X, 2085R0204X
PAMD4302742085R0202X
NY2141702085R0202X
NJ25MA083010002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA107127Medicare ID - Type Unspecified
PA101753529Medicaid
PA1017535290001Medicaid
PA1913999OtherHIGHMARK BLUE SHIELD
I18277Medicare UPIN
PA101753529OtherAMERICHOICE OF PA
PA9452100OtherPHCS
PAP00402153OtherRRMC
PA107127D2YMedicare PIN
PA231955165OtherAETNA USHC
PA231955165OtherINTERGROUP SERVICES
PA300367442OtherKEYSTONE MERCY
PA2781538000OtherIBC KHPE
NJP00435093OtherRRMC
NJ118947VSBMedicare PIN
PAMD430274OtherHEALTH PARTNERS
PAPA7584OtherHEALTHNET
NJ0148679Medicaid