Healthcare Provider Details

I. General information

NPI: 1689718629
Provider Name (Legal Business Name): JONATHAN S LEIBOWITZ,MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 55TH ST
BROOKLYN NY
11219-4202
US

IV. Provider business mailing address

1343 55TH ST
BROOKLYN NY
11219-4202
US

V. Phone/Fax

Practice location:
  • Phone: 718-972-7222
  • Fax:
Mailing address:
  • Phone: 718-972-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number198424
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number198424
License Number StateNY

VIII. Authorized Official

Name: DR. JONATHAN LEIBOWITZ
Title or Position: PRESIDENT
Credential: MD
Phone: 718-972-7222