Provider Demographics
NPI:1619089513
Name:LEBOVICS, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LEBOVICS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:STE 2550
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2176
Mailing Address - Country:US
Mailing Address - Phone:914-493-7337
Mailing Address - Fax:914-594-4317
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:STE 2550
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2176
Practice Address - Country:US
Practice Address - Phone:914-493-7337
Practice Address - Fax:914-594-4317
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153240207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0W0195OtherHEALTHNET
NY000000046384OtherGHI HMO
NY100013634OtherRAILROAD MEDICARE
NY138488OtherWELLCARE
NY4318638OtherAETNA PPO
NY003321OtherCONNECTICARE
NY0030975OtherGHI PPO
NY327628OtherMVP
NY153240OtherHIP
NY2172803OtherAETNA HMO #
NY69D491OtherEMPIRE BC/BS #
NYWS451OtherOXFORD
NY0W0195OtherHEALTHNET
NY69D491OtherEMPIRE BC/BS #