Provider Demographics
NPI:1518031186
Name:PULIDO, LEONIDAS B (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONIDAS
Middle Name:B
Last Name:PULIDO
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 1:175-25 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2942
Mailing Address - Country:US
Mailing Address - Phone:718-297-5091
Mailing Address - Fax:
Practice Address - Street 1:137-50 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3610
Practice Address - Country:US
Practice Address - Phone:718-298-5100
Practice Address - Fax:718-298-5130
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00195973Medicaid
NY00195973Medicaid