Provider Demographics
NPI:1508932872
Name:LEO, AIMEE LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:LYNN
Last Name:LEO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1618
Mailing Address - Country:US
Mailing Address - Phone:631-242-7272
Mailing Address - Fax:631-242-7292
Practice Address - Street 1:1400 DEER PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703
Practice Address - Country:US
Practice Address - Phone:631-242-7272
Practice Address - Fax:631-242-7292
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232592207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY833C3FW551OtherMEDICARE ID
NY833C3FW551OtherMEDICARE ID