Provider Demographics
NPI:1609048693
Name:LEONARDO, MARC ERIK (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ERIK
Last Name:LEONARDO
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 1:303 E 83RD ST
Mailing Address - Street 2:SUITE 23D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4318
Mailing Address - Country:US
Mailing Address - Phone:212-452-0878
Mailing Address - Fax:212-609-5858
Practice Address - Street 1:303 E 83RD ST
Practice Address - Street 2:SUITE 23D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4318
Practice Address - Country:US
Practice Address - Phone:212-452-0878
Practice Address - Fax:212-609-5858
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2145212084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry