Provider Demographics
NPI:1417917527
Name:RICKMAN, LEONARD ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ALAN
Last Name:RICKMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11622 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1017
Mailing Address - Country:US
Mailing Address - Phone:718-441-5400
Mailing Address - Fax:718-441-7765
Practice Address - Street 1:11622 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11418-1017
Practice Address - Country:US
Practice Address - Phone:718-441-5400
Practice Address - Fax:718-441-7765
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002549213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00415729Medicaid
NYT32090Medicare UPIN
NY77249Medicare ID - Type UnspecifiedGHI MEDICARE