Provider Demographics
NPI:1932143716
Name:LEBOVITCH, HERMAN (MD)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:
Last Name:LEBOVITCH
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 1:1 BROOKDALE PLZ STE 666
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3198
Mailing Address - Country:US
Mailing Address - Phone:718-240-5811
Mailing Address - Fax:718-206-6786
Practice Address - Street 1:1335 LINDEN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4751
Practice Address - Country:US
Practice Address - Phone:718-240-5100
Practice Address - Fax:718-206-6786
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01446762Medicaid
NY70H381Medicare ID - Type Unspecified
NY01446762Medicaid