Provider Demographics
NPI:1235214313
Name:LEON, MARIE LAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LAURA
Last Name:LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:441 9TH AVE
Mailing Address - Street 2:CREDENTIALING 3RD FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1623
Mailing Address - Country:US
Mailing Address - Phone:646-680-2894
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:2832 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-5132
Practice Address - Country:US
Practice Address - Phone:718-240-2000
Practice Address - Fax:718-240-2260
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY196577208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01682782Medicaid
NYA400107842Medicare PIN