Provider Demographics
NPI:1780606970
Name:LEREBOURS, FRANTZ (MD)
Entity type:Individual
Prefix:DR
First Name:FRANTZ
Middle Name:
Last Name:LEREBOURS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22812 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1846
Mailing Address - Country:US
Mailing Address - Phone:718-528-3206
Mailing Address - Fax:212-939-2759
Practice Address - Street 1:22812 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1846
Practice Address - Country:US
Practice Address - Phone:718-528-3206
Practice Address - Fax:212-939-2759
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154863207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00893774Medicaid
NY51857Medicare ID - Type Unspecified
NY00893774Medicaid