Healthcare Provider Details

I. General information

NPI: 1457589103
Provider Name (Legal Business Name): ANTOINETTE BRIGITTE BALEBA-LEKANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST NY METHODIST HOSPITAL
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

2 CATHARINE ST P O BOX 550
POUGHKEEPSIE NY
12601-3100
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-5388
  • Fax:
Mailing address:
  • Phone: 845-790-2677
  • Fax: 845-790-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number561818
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: