Basic Information
| Provider Information | |||||||||
| NPI: | 1275542177 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KOCHMAN, LEBOWITZ & MOGIL, MD'S, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 AVENUE J | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112303605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186450600 | ||||||||
| FaxNumber: | 7186924456 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 AVENUE J | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112303605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186450600 | ||||||||
| FaxNumber: | 7186924456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 06/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | RAIFMAN | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7186450600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 01634275 | 05 | NY | MEDICAID |