Provider Demographics
NPI:1508075938
Name:LEITL, HELEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:HELEN
Middle Name:
Last Name:LEITL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 KELLUM ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3867
Mailing Address - Country:US
Mailing Address - Phone:516-671-1111
Mailing Address - Fax:516-671-7673
Practice Address - Street 1:SCO FAMILY OF SERVICES, INFIRMARY
Practice Address - Street 2:PARK AND DOWNING AVENUES
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579
Practice Address - Country:US
Practice Address - Phone:516-671-1111
Practice Address - Fax:516-671-7673
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380854363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics