1750456406 NPI number — MARIE LAURA LEON M.D P.C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750456406 NPI number — MARIE LAURA LEON M.D P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIE LAURA LEON M.D P.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750456406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
441 9TH AVE
Provider Second Line Business Mailing Address:
ACP CREDENTIALING OFFICE - 3RD FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001-1623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-680-2894
Provider Business Mailing Address Fax Number:
516-542-5556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
391 EASTERN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11216-4153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-613-1600
Provider Business Practice Location Address Fax Number:
718-613-1666
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIMPSON
Authorized Official First Name:
MARLENA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
646-680-2894

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  196577 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01682782 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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