Provider Demographics
NPI:1417986969
Name:LEICHTER, RICHARD SCOTT (MA,PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SCOTT
Last Name:LEICHTER
Suffix:
Gender:M
Credentials:MA,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 TALLMADGE TRL
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2327
Mailing Address - Country:US
Mailing Address - Phone:631-473-6418
Mailing Address - Fax:
Practice Address - Street 1:28 N COUNTRY RD
Practice Address - Street 2:104
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-1518
Practice Address - Country:US
Practice Address - Phone:631-331-6047
Practice Address - Fax:631-331-7953
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist