Healthcare Provider Details

I. General information

NPI: 1184557217
Provider Name (Legal Business Name): RISA ASHIRA LEBOWITZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8216 GRENFELL ST
KEW GARDENS NY
11415-1306
US

IV. Provider business mailing address

8216 GRENFELL ST
KEW GARDENS NY
11415-1306
US

V. Phone/Fax

Practice location:
  • Phone: 917-477-9509
  • Fax:
Mailing address:
  • Phone: 917-477-9509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: