Healthcare Provider Details

I. General information

NPI: 1144228206
Provider Name (Legal Business Name): LENNIE HOBENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 05/28/2023
Certification Date: 05/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 OCEAN PKWY 1ST FLOOR
BROOKLYN NY
11230-4073
US

IV. Provider business mailing address

1762 MCDONALD AVE
BROOKLYN NY
11230-6907
US

V. Phone/Fax

Practice location:
  • Phone: 718-252-5300
  • Fax:
Mailing address:
  • Phone: 646-515-9968
  • Fax: 718-252-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number210050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: