1215921283 NPI number — MARY P LEAHY MD

Table of content: MARY P LEAHY MD (NPI 1215921283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215921283 NPI number — MARY P LEAHY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEAHY
Provider First Name:
MARY
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1215921283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 GRAND ST
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10990-1035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-987-3952
Provider Business Mailing Address Fax Number:
845-987-5979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CROSFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 318
Provider Business Practice Location Address City Name:
WEST NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10994-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-353-5600
Provider Business Practice Location Address Fax Number:
845-353-5668
Provider Enumeration Date:
09/07/2005

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: 207R00000X , with the licence number:  1671161 , 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: 2594362 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0057864 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01852895 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132995699 . This is a "HEALTH NOW" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0D2175 . This is a "HEALTHNET OF NORTHEAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "HUDSON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20533 . This is a "AETNA/USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4096837 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "CIGNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23E881 . This is a "BC/BS EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8175389003 . This is a "CIGNA HMO, POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "HORIZON HEALTHCARE OF NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "INDECS(ORANGE-ULSTER SCHL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "LOCAL 1199" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040426012111 . This is a "FIDELIS (MEDICAID HMO)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "BEECH STREET NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "FAM HEALTH PLUS(HUDSON HP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45022P . This is a "HIP" identifier . This identifiers is of the category "OTHER".




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