Provider Demographics
NPI:1083836811
Name:GENUS COWAN, LEONIE (MS RDCN)
Entity Type:Individual
Prefix:
First Name:LEONIE
Middle Name:
Last Name:GENUS COWAN
Suffix:
Gender:F
Credentials:MS RDCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 ROUTE 300
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1738
Mailing Address - Country:US
Mailing Address - Phone:845-564-9853
Mailing Address - Fax:845-564-6974
Practice Address - Street 1:1607 ROUTE 300
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1738
Practice Address - Country:US
Practice Address - Phone:845-564-9853
Practice Address - Fax:845-564-6974
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001475-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001475-1OtherLICENSED DIETITICIAN