Provider Demographics
NPI:1083780795
Name:BILENKIN, LEONID (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:BILENKIN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GLEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590
Mailing Address - Country:US
Mailing Address - Phone:914-533-1182
Mailing Address - Fax:
Practice Address - Street 1:55 HOLLY HILL LN
Practice Address - Street 2:110
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6074
Practice Address - Country:US
Practice Address - Phone:203-863-4670
Practice Address - Fax:203-863-4674
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003739363AM0700X
CT002258363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002258OtherCONNECTICUT STATE PHYSICIAN ASSISTANT LICENSE
NY003739-1OtherNY STATE PHYSICIAN ASSISTANT LICENSE