Provider Demographics
NPI:1962442780
Name:CERVANTES, LOBER (MD)
Entity Type:Individual
Prefix:DR
First Name:LOBER
Middle Name:
Last Name:CERVANTES
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 1:10850 62ND DR
Mailing Address - Street 2:STE LA
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-8420
Mailing Address - Country:US
Mailing Address - Phone:718-896-8000
Mailing Address - Fax:718-206-7169
Practice Address - Street 1:10850 62ND DR
Practice Address - Street 2:STE LA
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-8420
Practice Address - Country:US
Practice Address - Phone:718-896-8000
Practice Address - Fax:718-896-8009
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2347372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2646399Medicaid
NY0206FEMedicare ID - Type Unspecified
NYI33209Medicare UPIN