Provider Demographics
NPI:1619174059
Name:STOLYAR, LEON
Entity Type:Individual
Prefix:PROF
First Name:LEON
Middle Name:
Last Name:STOLYAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 S ONEIDA ST UNIT 1B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1700
Mailing Address - Country:US
Mailing Address - Phone:303-333-2035
Mailing Address - Fax:303-333-0052
Practice Address - Street 1:970 S ONEIDA ST UNIT 1B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1700
Practice Address - Country:US
Practice Address - Phone:303-333-2035
Practice Address - Fax:303-333-0052
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4315410001Medicare ID - Type Unspecified