Provider Demographics
NPI:1548228190
Name:GUREVICH, LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:GUREVICH
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 1:301 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1570
Mailing Address - Country:US
Mailing Address - Phone:716-677-6500
Mailing Address - Fax:716-677-6507
Practice Address - Street 1:301 STERLING DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1570
Practice Address - Country:US
Practice Address - Phone:716-677-6500
Practice Address - Fax:716-677-6507
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203313207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000524409002OtherHEALTH NOW NEW YORK
NY01843365Medicaid
NY0808288OtherINDEPENDENT HEALTH
NYAA0654OtherMEDICARE PTAN
NY01843365Medicaid
NY000524409002OtherHEALTH NOW NEW YORK