Provider Demographics
NPI:1134315807
Name:ELZEY, LEONARD DEMETRIUS (D,DS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:DEMETRIUS
Last Name:ELZEY
Suffix:
Gender:M
Credentials:D,DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4873
Mailing Address - Country:US
Mailing Address - Phone:845-343-0087
Mailing Address - Fax:845-343-0014
Practice Address - Street 1:40 GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4873
Practice Address - Country:US
Practice Address - Phone:845-343-0087
Practice Address - Fax:845-343-0014
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041-0991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice