1700454071 NPI number — DR. FRUMENTIA MELISSA LEON M.D.

Table of content: DR. FRUMENTIA MELISSA LEON M.D. (NPI 1700454071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700454071 NPI number — DR. FRUMENTIA MELISSA LEON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEON
Provider First Name:
FRUMENTIA
Provider Middle Name:
MELISSA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1700454071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/01/2022
NPI Reactivation Date:
09/01/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
506 6TH STREET, DEPARTMENT OF ANESTHESIOLOGY
Provider Second Line Business Mailing Address:
NEW YORK PRESBYTERIAN-BROOKLYN METHODIST HOSPITAL
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-780-3970
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 MEMORIAL MEDICAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32117-5167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-231-3147
Provider Business Practice Location Address Fax Number:
386-231-3695
Provider Enumeration Date:
06/14/2021

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: 207L00000X , with the licence number:  ME177444 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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