Provider Demographics
NPI:1013538917
Name:ALYACOUB, LEEN HOSAM (MBBS)
Entity Type:Individual
Prefix:MS
First Name:LEEN
Middle Name:HOSAM
Last Name:ALYACOUB
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGH STREET, D2-76 BUFFALO, NY 14203, BUFFALO GENER
Mailing Address - Street 2:
Mailing Address - City:BUFFALL
Mailing Address - State:NY
Mailing Address - Zip Code:14203
Mailing Address - Country:US
Mailing Address - Phone:716-859-4828
Mailing Address - Fax:
Practice Address - Street 1:100 HIGH STREET, D2-76 BUFFALO, NY 14203, BUFFALO GENER
Practice Address - Street 2:
Practice Address - City:BUFFALL
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-859-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2023-06-26
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2023-06-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program