Provider Demographics
NPI:1336226570
Name:LEBETKIN, LEWIS MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:MARTIN
Last Name:LEBETKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:107 NORTHERN BLVD.
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-466-8400
Mailing Address - Fax:516-466-8402
Practice Address - Street 1:107 NORTHERN BLVD.
Practice Address - Street 2:SUITE 208
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-466-8400
Practice Address - Fax:516-466-8402
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY134743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12690Medicare UPIN