Provider Demographics
NPI:1497831986
Name:MULLEN, LEON (MD)
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:
Last Name:MULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MERRICK AVENUE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1580
Mailing Address - Country:US
Mailing Address - Phone:516-542-0255
Mailing Address - Fax:516-542-0276
Practice Address - Street 1:30 MERRICK AVENUE
Practice Address - Street 2:SUITE 105
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1580
Practice Address - Country:US
Practice Address - Phone:516-542-0255
Practice Address - Fax:516-542-0276
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132791207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00663103Medicaid
NY54A071Medicare PIN