Provider Demographics
NPI:1538331384
Name:ROBERT LEBOVITCH DDS PC
Entity Type:Organization
Organization Name:ROBERT LEBOVITCH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-357-2323
Mailing Address - Street 1:400 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3429
Mailing Address - Country:US
Mailing Address - Phone:845-357-2323
Mailing Address - Fax:845-357-8338
Practice Address - Street 1:400 ROUTE 59
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3429
Practice Address - Country:US
Practice Address - Phone:845-357-2323
Practice Address - Fax:845-357-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048849-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02596454Medicaid