MEDICARE: ALEXANDRA PAIGE LEBENTAL MD

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	207V00000X	Obstetrics & Gynecology Physician	MT215569	PA
2	207V00000X	Obstetrics & Gynecology Physician	317554	NY

General Provider Information

NPI Number	:	1770075939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA PAIGE LEBENTAL MD

Provider Business Mailing Address
First Line	:	28-25 JACKSON AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28-25 JACKSON AVENUE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2920
Country	:	US
Telephone Number	:	646-962-4900
Fax Number	:

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

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	08/10/2023

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