Provider Demographics
NPI:1598744039
Name:DE LEON, DEOGENES G (MD)
Entity Type:Individual
Prefix:
First Name:DEOGENES
Middle Name:G
Last Name:DE LEON
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:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-0809
Mailing Address - Country:US
Mailing Address - Phone:845-294-8888
Mailing Address - Fax:845-294-1669
Practice Address - Street 1:1121 N CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4405
Practice Address - Country:US
Practice Address - Phone:407-933-1221
Practice Address - Fax:407-933-1132
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228453207R00000X, 207RC0200X, 207RP1001X
FLME154054207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00378687OtherRAILROAD MEDICARE PIN
NY02432997Medicaid
NY95S301Medicare PIN
I00259Medicare UPIN