1508002056 NPI number — MRS. LESLIE MARIE JEANNITON DPT

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 1508002056 NPI number — MRS. LESLIE MARIE JEANNITON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEANNITON
Provider First Name:
LESLIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JEANNITON-TORBATI
Provider Other First Name:
LESLIE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508002056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
172 NOYE LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODMERE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-220-7776
Provider Business Mailing Address Fax Number:
516-374-7477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
571 MCDONALD AVE.
Provider Second Line Business Practice Location Address:
YELED V' YALDA
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-686-3700
Provider Business Practice Location Address Fax Number:
718-436-8851
Provider Enumeration Date:
01/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  009516-1 , 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)





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