Provider Demographics
NPI:1346468162
Name:SCHONBRUN, LESLIE D (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:D
Last Name:SCHONBRUN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 REID AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3507
Mailing Address - Country:US
Mailing Address - Phone:516-767-0599
Mailing Address - Fax:
Practice Address - Street 1:45 REID AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3507
Practice Address - Country:US
Practice Address - Phone:516-767-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015658-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ07Q4Medicare ID - Type UnspecifiedMEDICARE PROVIDER #