Healthcare Provider Details

I. General information

NPI: 1275525446
Provider Name (Legal Business Name): STEVEN MARK KOBREN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 GREAT NECK RD SUITE 300
GREAT NECK NY
11021-4315
US

IV. Provider business mailing address

488 GREAT NECK RD SUITE 300
GREAT NECK NY
11021-4315
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-6747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number159005
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number159005
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: