Provider Demographics
NPI:1518627785
Name:ERWIN LEREBOURS MEDICAL PLLC
Entity Type:Organization
Organization Name:ERWIN LEREBOURS MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEREBOURS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-317-5539
Mailing Address - Street 1:2 CARMAN RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5645
Mailing Address - Country:US
Mailing Address - Phone:718-208-4433
Mailing Address - Fax:718-799-1415
Practice Address - Street 1:5202 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3942
Practice Address - Country:US
Practice Address - Phone:718-208-4433
Practice Address - Fax:718-799-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty