Provider Demographics
NPI:1144228206
Name:HOBENSON, LENNIE
Entity Type:Individual
Prefix:
First Name:LENNIE
Middle Name:
Last Name:HOBENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 MCDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6907
Mailing Address - Country:US
Mailing Address - Phone:646-515-9968
Mailing Address - Fax:718-252-5010
Practice Address - Street 1:1115 OCEAN PKWY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4073
Practice Address - Country:US
Practice Address - Phone:718-252-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12V701Medicare PIN