1508980715 NPI number — MARTIN H. LEBOWITZ, M.D., INC.

Table of content: (NPI 1508980715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508980715 NPI number — MARTIN H. LEBOWITZ, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN H. LEBOWITZ, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508980715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11999 SAN VICENTE BLVD
Provider Second Line Business Mailing Address:
STE. 440
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90049-5131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-471-5852
Provider Business Mailing Address Fax Number:
310-471-3958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9700 VENICE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULVER CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90232-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-204-5825
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEBOWITZ
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
INC.
Authorized Official Telephone Number:
310-204-5824

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  A20150 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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