Provider Demographics
NPI:1790088722
Name:LEONARD S LEBOW MD PA
Entity Type:Organization
Organization Name:LEONARD S LEBOW MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEBOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-748-4433
Mailing Address - Street 1:7800 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6757
Mailing Address - Country:US
Mailing Address - Phone:954-748-4433
Mailing Address - Fax:954-748-9411
Practice Address - Street 1:7800 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6757
Practice Address - Country:US
Practice Address - Phone:954-748-4433
Practice Address - Fax:954-748-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME201712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty