Healthcare Provider Details

I. General information

NPI: 1013674928
Provider Name (Legal Business Name): JESSICA KORASADOWICZ LEBENTAL FNP DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2021
Last Update Date: 11/27/2021
Certification Date: 11/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 5TH AVE
NEW YORK NY
10021-4157
US

IV. Provider business mailing address

30 PARK PL APT 55B
NEW YORK NY
10007-2576
US

V. Phone/Fax

Practice location:
  • Phone: 212-392-1075
  • Fax:
Mailing address:
  • Phone: 862-432-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF347688
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: