Provider Demographics
NPI:1356090914
Name:LEAHY, COLLEEN (DO)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:LEAHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 STEEPLE DR
Mailing Address - Street 2:
Mailing Address - City:KINTNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18930-1652
Mailing Address - Country:US
Mailing Address - Phone:631-879-1825
Mailing Address - Fax:
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program