Healthcare Provider Details

I. General information

NPI: 1962442780
Provider Name (Legal Business Name): LOBER CERVANTES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10850 62ND DR STE LA
FOREST HILLS NY
11375-8420
US

IV. Provider business mailing address

10850 62ND DR STE LA
FOREST HILLS NY
11375-8420
US

V. Phone/Fax

Practice location:
  • Phone: 718-896-8000
  • Fax: 718-896-8009
Mailing address:
  • Phone: 718-896-8000
  • Fax: 718-206-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number234737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: