Provider Demographics
NPI:1962561894
Name:LEBOWITZ, JONATHAN LOUIS (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:LOUIS
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 1:775 PARK AVENUE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-424-0101
Mailing Address - Fax:631-424-0165
Practice Address - Street 1:775 PARK AVENUE
Practice Address - Street 2:SUITE 225
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-424-0101
Practice Address - Fax:631-424-0165
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152060208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E44812Medicare UPIN
42F501Medicare ID - Type Unspecified