MEDICARE: DR. FRANTZ LEREBOURS M.D.

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	207W00000X	Ophthalmology Physician	154863	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780606970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANTZ LEREBOURS M.D.

Provider Business Mailing Address
First Line	:	22812 LINDEN BLVD
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1846
Country	:	US
Telephone Number	:	718-528-3206
Fax Number	:	212-939-2759

Provider Business Practice Location Address
First Line	:	22812 LINDEN BLVD
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1846
Country	:	US
Telephone Number	:	718-528-3206
Fax Number	:	212-939-2759

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/02/2012

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