MEDICARE: DR. EVA LEBRON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	046581	NY

General Provider Information

NPI Number	:	1497882716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVA LEBRON DDS

Provider Business Mailing Address
First Line	:	436 FORT WASHINGTON AVE
Second Line	:	SUITE 1 B
City	:	NEW YORK
State	:	NY
Zip	:	10033-3507
Country	:	US
Telephone Number	:	212-923-6280
Fax Number	:	212-568-8190

Provider Business Practice Location Address
First Line	:	436 FORT WASHINGTON AVE
Second Line	:	SUITE 1 B
City	:	NEW YORK
State	:	NY
Zip	:	10033-3507
Country	:	US
Telephone Number	:	212-923-6280
Fax Number	:	212-568-8190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	11/16/2012

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