Provider Demographics
NPI:1598857443
Name:LEDO MEDICAL REHABILITATION PLLC
Entity Type:Organization
Organization Name:LEDO MEDICAL REHABILITATION PLLC
Other - Org Name:PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-382-0010
Mailing Address - Street 1:2118 CONEY ISLAND AVENUE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223
Mailing Address - Country:US
Mailing Address - Phone:718-382-0010
Mailing Address - Fax:718-382-6401
Practice Address - Street 1:2118 CONEY ISLAND AVENUE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223
Practice Address - Country:US
Practice Address - Phone:718-382-0010
Practice Address - Fax:718-382-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191844208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01591804Medicaid
NY92E881Medicare ID - Type Unspecified
NY01591804Medicaid