Provider Demographics
NPI:1598011421
Name:LEON, MARJORIE YOLANDA (CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:YOLANDA
Last Name:LEON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:PEGUERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1229
Mailing Address - Country:US
Mailing Address - Phone:718-679-8540
Mailing Address - Fax:
Practice Address - Street 1:212 CRYSTAL RUN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4009
Practice Address - Country:US
Practice Address - Phone:914-493-8431
Practice Address - Fax:914-493-3166
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY659587163W00000X
NY383039363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner