Active NPI
Lawrence Koblenz, MD
- Gastroenterology Physician
- Great Neck, NY
National Provider Identifier
1699793620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 120369
- Practice address
- 32 Portico PL Ste 1a
Great Neck, NY 11021-2021 - Phone
- (718) 708-7000
- Fax
- (516) 482-2462
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hepatology Physician | 207RI0008X | 120369 | NY | |
| Gastroenterology Physician | 207RG0100X | 120369 | NY | Primary |
Addresses
Primary practice location
32 Portico PL Ste 1a
Great Neck, NY 11021-2021
Mailing address
32 Portico PL Ste 1a
Great Neck, NY 11021-2021
Phone (718) 708-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120369 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606262400000",
"number": "1699793620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32 PORTICO PL STE 1A",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110212021",
"telephone_number": "718-708-7000",
"fax_number": "516-482-2462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32 PORTICO PL STE 1A",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110212021",
"telephone_number": "718-708-7000",
"fax_number": "516-482-2462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOBLENZ",
"first_name": "LAWRENCE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2020-11-25",
"certification_date": "2020-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "207RI0008X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hepatology",
"state": "NY",
"license": "120369",
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "NY",
"license": "120369",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Neck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.