Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 141913 | NY |
NPI | 1013902444 |
---|---|
Provider Name | Dr. Mark Lebwohl |
First Address | New York, NY 10028-4500 |
Second Address | New York, NY 10029-6501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 12/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B18765 | (02) | NY |