Provider Demographics
NPI:1992993612
Name:MOCOMBE LUCIEN D MD PC
Entity type:Organization
Organization Name:MOCOMBE LUCIEN D MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOCOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-859-2525
Mailing Address - Street 1:3016 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2642
Mailing Address - Country:US
Mailing Address - Phone:718-859-2525
Mailing Address - Fax:718-859-8852
Practice Address - Street 1:3016 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2642
Practice Address - Country:US
Practice Address - Phone:718-859-2525
Practice Address - Fax:718-859-8852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY183811Medicaid
WEK 391OtherMEDICARE