Provider Demographics
NPI:1083656037
Name:LEEDS, ANDREA JILL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:JILL
Last Name:LEEDS
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 1:3178 LEE PL
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5038
Mailing Address - Country:US
Mailing Address - Phone:516-826-7981
Mailing Address - Fax:
Practice Address - Street 1:3178 LEE PL
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5038
Practice Address - Country:US
Practice Address - Phone:516-826-7981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189517208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY36573OtherVYTRA
NY0P366POtherHIP
NY450335OtherAETNA HMO
NYOC2421OtherHEALTHNET
NY0732277OtherCIGNA
NY4350228OtherAETNA PPO
NYAP329OtherOXFORD
NY1062927OtherUNITED HEALTHCARE
NY113174437OtherHORIZON
NY40H601OtherEMPIRE BLUE CROSS BLUE SH
NYF49807Medicare UPIN