Provider Demographics
NPI:1326033606
Name:SEIDEN, LESLIE ANN (MS,RD,CDE)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:SEIDEN
Suffix:
Gender:F
Credentials:MS,RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 167TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1325
Mailing Address - Country:US
Mailing Address - Phone:718-969-7266
Mailing Address - Fax:718-969-7266
Practice Address - Street 1:7318 167TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1325
Practice Address - Country:US
Practice Address - Phone:718-969-7266
Practice Address - Fax:718-969-7266
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2010-07-22
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NY000124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04820Medicare ID - Type Unspecified
NYP42819Medicare UPIN