Provider Demographics
NPI:1750075263
Name:LEBRON, DAVID ANTONIO (MPS, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANTONIO
Last Name:LEBRON
Suffix:
Gender:M
Credentials:MPS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 CHURCH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4256
Mailing Address - Country:US
Mailing Address - Phone:516-943-6900
Mailing Address - Fax:
Practice Address - Street 1:500 LEONARD BLVD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3933
Practice Address - Country:US
Practice Address - Phone:516-488-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY41572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer