Provider Demographics
NPI:1073585923
Name:BESA-LORIA, LEILANI PALMA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEILANI
Middle Name:PALMA
Last Name:BESA-LORIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 REGAL WALK
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1770
Mailing Address - Country:US
Mailing Address - Phone:718-494-3981
Mailing Address - Fax:718-698-9666
Practice Address - Street 1:11905 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2421
Practice Address - Country:US
Practice Address - Phone:718-843-3003
Practice Address - Fax:718-843-3504
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00751964Medicaid