1992793533 NPI number — JAMES SAMUEL LEONARD D.P.M.

Table of content: (NPI 1376053819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992793533 NPI number — JAMES SAMUEL LEONARD D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEONARD
Provider First Name:
JAMES
Provider Middle Name:
SAMUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

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:
1992793533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 GUTHRIE SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAYRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18840-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-888-5858
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1095 COMMONS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORTLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13045-1669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-756-5422
Provider Business Practice Location Address Fax Number:
607-756-5488
Provider Enumeration Date:
10/07/2005

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: 213EP1101X , with the licence number:  N004037-1 , 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)

  • Identifier: 00989262 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005567056 . This is a "AETNA PIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426013555 . This is a "FIDELISCARE NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11123258 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: UNIVERA HEALTHCARE C . This is a "00040115201" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 043587567 . This is a "EXCELLUS BLUE SHIELD CNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 480033278 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043587567001 . This is a "RMSCO INC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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