Provider Demographics
NPI:1699722587
Name:LEREBOURS, ERWIN (MD)
Entity type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:LEREBOURS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LOUIS JJMI
Other - Middle Name:ERWIN
Other - Last Name:LEREBOURS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2 CARMAN RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5645
Mailing Address - Country:US
Mailing Address - Phone:718-208-4433
Mailing Address - Fax:718-799-1415
Practice Address - Street 1:5202 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3942
Practice Address - Country:US
Practice Address - Phone:718-208-4433
Practice Address - Fax:718-799-1415
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228242-1207V00000X
NY228242207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02610153Medicaid