Provider Demographics
NPI:1588639389
Name:DIRE, J LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:J LEONARD
Middle Name:
Last Name:DIRE
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 MEMORIAL HWY
Mailing Address - Street 2:STE. 1-1
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5635
Mailing Address - Country:US
Mailing Address - Phone:914-235-3535
Mailing Address - Fax:914-235-4108
Practice Address - Street 1:175 MEMORIAL HWY
Practice Address - Street 2:STE. 1-1
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5635
Practice Address - Country:US
Practice Address - Phone:914-235-3535
Practice Address - Fax:914-235-4108
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172283207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY65F4221351OtherMEDICARE
NY01694944Medicaid
E62478Medicare UPIN
NY65F421Medicare ID - Type Unspecified