1851352058 NPI number — DR. DOMENICO LEUCI MD

Table of content: DR. DOMENICO LEUCI MD (NPI 1851352058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851352058 NPI number — DR. DOMENICO LEUCI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEUCI
Provider First Name:
DOMENICO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1851352058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
365 HARRY L DR
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13790-1471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-754-9870
Provider Business Mailing Address Fax Number:
607-785-9862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
365 HARRY L DR STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13790-1471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-729-5805
Provider Business Practice Location Address Fax Number:
607-729-7714
Provider Enumeration Date:
03/29/2006

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: 207V00000X , with the licence number:  232736 , 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: 02630697 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4127900 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10087636 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".