Provider Demographics
NPI:1902872468
Name:LEBRON, CARMEN H (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:H
Last Name:LEBRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARMEN
Other - Middle Name:H
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:401 ROUTE 73 N STE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3426
Mailing Address - Country:US
Mailing Address - Phone:973-243-0002
Mailing Address - Fax:
Practice Address - Street 1:745 NORTHFIELD AVE STE 7
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1136
Practice Address - Country:US
Practice Address - Phone:973-243-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07852900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ061691342OtherTAX ID #
NJ460862157OtherINDIVIDUAL TAX ID NUMBER
NJ460862157OtherINDIVIDUAL TAX ID NUMBER
NJ106279Medicare PIN