Provider Demographics
NPI:1528004157
Name:LEAL, DAVID DANIEL JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DANIEL
Last Name:LEAL
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:170 WILLIAM ST
Mailing Address - Street 2:ROOM 354
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2612
Mailing Address - Country:US
Mailing Address - Phone:646-588-2602
Mailing Address - Fax:212-312-5855
Practice Address - Street 1:170 WILLIAM ST
Practice Address - Street 2:ROOM 354
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2612
Practice Address - Country:US
Practice Address - Phone:646-588-2602
Practice Address - Fax:212-312-5855
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY584049367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86150UOtherBLUE CROSS & BLUE SHIELD
TX86150UOtherBLUE CROSS & BLUE SHIELD
8G4852Medicare ID - Type Unspecified