Healthcare Provider Details

I. General information

NPI: 1972871804
Provider Name (Legal Business Name): BERNICE FRANCESCA LECAROS FORBES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 MONTAGUE ST
BROOKLYN NY
11201-3628
US

IV. Provider business mailing address

55 WATER STREET 2ND FLOOR CRED DEPT
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 718-422-8000
  • Fax: 718-422-8265
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number259988
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: