Provider Demographics
NPI:1144225350
Name:LEONTE, GABRIEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:T
Last Name:LEONTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4927
Mailing Address - Country:US
Mailing Address - Phone:631-376-3000
Mailing Address - Fax:631-376-4147
Practice Address - Street 1:1000 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4927
Practice Address - Country:US
Practice Address - Phone:631-376-3000
Practice Address - Fax:631-224-8560
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02396367Medicaid
NYP00165413OtherRAILROAD MEDICARE
NY75S631OtherBLUE CROSS BLUE SHIELD
NY2582729OtherAETNA/US HEALTHCARE
NY153018OtherVYTRA HEALTHCARE
NY2582729OtherAETNA/US HEALTHCARE
NY75S631Medicare ID - Type UnspecifiedMEDICARE PROVIDER #