Healthcare Provider Details

I. General information

NPI: 1720479058
Provider Name (Legal Business Name): ESTHER LEBOVIC FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 GRAND CONCOURSE
BRONX NY
10456-3901
US

IV. Provider business mailing address

180 HARBORVIEW N
LAWRENCE NY
11559-1904
US

V. Phone/Fax

Practice location:
  • Phone: 718-681-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403358
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33339379
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: