1528638780 NPI number — MRS. CHI TU TRUONG-LEISNER PMHNP-BC

Table of content: MRS. CHI TU TRUONG-LEISNER PMHNP-BC (NPI 1528638780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528638780 NPI number — MRS. CHI TU TRUONG-LEISNER PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUONG-LEISNER
Provider First Name:
CHI
Provider Middle Name:
TU
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
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:
1528638780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/06/2022
NPI Reactivation Date:
07/15/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
857 S OYSTER BAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHPAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11714-1030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 FULTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMPSTEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11550-4553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-571-1300
Provider Business Practice Location Address Fax Number:
516-572-1741
Provider Enumeration Date:
06/30/2021

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 403977 , 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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