Provider Demographics
NPI:1114268307
Name:HORDEN, LEAH ESTELLE
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:ESTELLE
Last Name:HORDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 KENMORE AVE
Mailing Address - Street 2:APT 12
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1371
Mailing Address - Country:US
Mailing Address - Phone:716-297-0798
Mailing Address - Fax:716-297-0998
Practice Address - Street 1:1154 KENMORE AVE
Practice Address - Street 2:APT 12
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-1371
Practice Address - Country:US
Practice Address - Phone:716-297-0798
Practice Address - Fax:716-297-0998
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY431429239OtherNYS LICENSE