Provider Demographics
NPI:1871761684
Name:RICHARD I LEBOVIC
Entity type:Organization
Organization Name:RICHARD I LEBOVIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEBOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-613-1166
Mailing Address - Street 1:PO BOX 6117
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-6117
Mailing Address - Country:US
Mailing Address - Phone:732-613-1166
Mailing Address - Fax:
Practice Address - Street 1:623 NORTH WOOD AVENUE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036
Practice Address - Country:US
Practice Address - Phone:908-925-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1088620001Medicare NSC
NJ050805Medicare UPIN