Provider Demographics
NPI:1255693008
Name:LEAHY-COTSALAS, DEBORAH JUDITH
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JUDITH
Last Name:LEAHY-COTSALAS
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 1:2247 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2523
Mailing Address - Country:US
Mailing Address - Phone:516-857-4055
Mailing Address - Fax:
Practice Address - Street 1:2247 HENRY ST
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2523
Practice Address - Country:US
Practice Address - Phone:516-857-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist