Provider Demographics
NPI:1619562790
Name:LECCY, EMMANUEL
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:
Last Name:LECCY
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:PO BOX 970609
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33097-0609
Mailing Address - Country:US
Mailing Address - Phone:954-895-8827
Mailing Address - Fax:
Practice Address - Street 1:4737 NW 57TH PL
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2309
Practice Address - Country:US
Practice Address - Phone:954-895-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor