Provider Demographics
NPI:1194836361
Name:LEBENSFELD, KIRK (DPM)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:
Last Name:LEBENSFELD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 55TH ST FRNT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6119
Mailing Address - Country:US
Mailing Address - Phone:212-888-7719
Mailing Address - Fax:
Practice Address - Street 1:401 E 55TH ST FRNT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6119
Practice Address - Country:US
Practice Address - Phone:212-888-7719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04182213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0042834OtherGHI
NY00979837Medicaid
NYP43412Medicare ID - Type Unspecified
NYP43411Medicare ID - Type Unspecified
NY00979837Medicaid