Provider Demographics
NPI:1073688313
Name:DENIS LEBLANG DPM PC
Entity Type:Organization
Organization Name:DENIS LEBLANG DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST,OWNER,CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-268-8282
Mailing Address - Street 1:285 N ROUTE 303
Mailing Address - Street 2:15
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1425
Mailing Address - Country:US
Mailing Address - Phone:845-268-8282
Mailing Address - Fax:
Practice Address - Street 1:285 N ROUTE 303
Practice Address - Street 2:15
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-1425
Practice Address - Country:US
Practice Address - Phone:845-268-8282
Practice Address - Fax:845-268-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002957213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00497338Medicaid
NYPJ7441OtherBCBS
NY00497338Medicaid
NYT50922Medicare UPIN
NYPXW212Medicare PIN
NYDE0PXW2120Medicare PIN
NYPJ7441OtherBCBS
POO199611Medicare PIN