Provider Demographics
NPI:1255331799
Name:MOCOMBE, LUCIEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIEN
Middle Name:D
Last Name:MOCOMBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3016 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2642
Mailing Address - Country:US
Mailing Address - Phone:718-859-2525
Mailing Address - Fax:347-750-7088
Practice Address - Street 1:3016 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2642
Practice Address - Country:US
Practice Address - Phone:718-859-2525
Practice Address - Fax:347-750-7088
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01249641Medicaid
NY145AF1Medicare ID - Type Unspecified
NY01249641Medicaid