Provider Demographics
NPI:1306392246
Name:LEONZON, GIAN ANTONIO (MSN, RN-BC, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:GIAN
Middle Name:ANTONIO
Last Name:LEONZON
Suffix:
Gender:M
Credentials:MSN, RN-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6601 BURNS ST APT 5P
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:917-704-7690
Mailing Address - Fax:
Practice Address - Street 1:161-10 JAMAICA AVE., 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-704-5488
Practice Address - Fax:718-704-5485
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY689712163W00000X
NY402198363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse