Healthcare Provider Details

I. General information

NPI: 1346860921
Provider Name (Legal Business Name): JORDAN LEBOVIC MD MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E 32ND ST FL 4
NEW YORK NY
10016-6055
US

IV. Provider business mailing address

700 HICKSVILLE RD STE 205
BETHPAGE NY
11714-3472
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-3986
  • Fax: 646-754-7539
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number335576
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: