Provider Demographics
NPI:1275542177
Name:KOCHMAN, LEBOWITZ & MOGIL, MD'S, LLP
Entity Type:Organization
Organization Name:KOCHMAN, LEBOWITZ & MOGIL, MD'S, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:718-645-0600
Mailing Address - Street 1:1301 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3605
Mailing Address - Country:US
Mailing Address - Phone:718-645-0600
Mailing Address - Fax:718-692-4456
Practice Address - Street 1:1301 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3605
Practice Address - Country:US
Practice Address - Phone:718-645-0600
Practice Address - Fax:718-692-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01634275Medicaid
NY01634275Medicaid
NY0164420001Medicare NSC