MEDICARE: DR. LUCIEN D MOCOMBE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	183811	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255331799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCIEN D MOCOMBE MD

Provider Business Mailing Address
First Line	:	3016 GLENWOOD RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2642
Country	:	US
Telephone Number	:	718-859-2525
Fax Number	:	347-750-7088

Provider Business Practice Location Address
First Line	:	3016 GLENWOOD RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2642
Country	:	US
Telephone Number	:	718-859-2525
Fax Number	:	347-750-7088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	02/09/2015

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