Provider Demographics
NPI:1447855853
Name:LEBRON, BLIMA
Entity type:Individual
Prefix:
First Name:BLIMA
Middle Name:
Last Name:LEBRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CEDAR LN UNIT 111
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2141
Mailing Address - Country:US
Mailing Address - Phone:845-200-4994
Mailing Address - Fax:
Practice Address - Street 1:295 W ROUTE 59
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5449
Practice Address - Country:US
Practice Address - Phone:845-200-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program