Provider Demographics
NPI:1134112824
Name:LEONARDI, CHRISTIAN (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:LEONARDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OLD PARK LANE
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776
Mailing Address - Country:US
Mailing Address - Phone:860-355-1149
Mailing Address - Fax:860-355-5957
Practice Address - Street 1:11 OLD PARK LANE
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776
Practice Address - Country:US
Practice Address - Phone:860-355-1149
Practice Address - Fax:860-355-5957
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT45397207R00000X
IL036111922207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111922Medicaid
CT008016289Medicaid
ILK11159Medicare ID - Type Unspecified
IL036111922Medicaid