Basic Information
| Provider Information | |||||||||
| NPI: | 1932143716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEBOVITCH | ||||||||
| FirstName: | HERMAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BROOKDALE PLZ STE 666 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112123198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405811 | ||||||||
| FaxNumber: | 7182066786 | ||||||||
| Practice Location | |||||||||
| Address1: | 1335 LINDEN BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112124751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405100 | ||||||||
| FaxNumber: | 7182066786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 11/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 192733 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01446762 | 05 | NY | MEDICAID |