Provider Demographics
NPI:1497826267
Name:MAX, LEONORE BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONORE
Middle Name:BETH
Last Name:MAX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEONORE
Other - Middle Name:
Other - Last Name:MAX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1103 CORTELYOU ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5303
Mailing Address - Country:US
Mailing Address - Phone:718-282-0170
Mailing Address - Fax:718-282-1008
Practice Address - Street 1:1103 CORTELYOU ROAD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5303
Practice Address - Country:US
Practice Address - Phone:718-282-0170
Practice Address - Fax:718-282-1008
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1456832080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF90279Medicare UPIN