Provider Demographics
NPI:1629291612
Name:SULTAN, LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:SULTAN
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 1:110 NORWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:ELBERON
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-8029
Mailing Address - Country:US
Mailing Address - Phone:732-728-1209
Mailing Address - Fax:
Practice Address - Street 1:255 FRANKLIN AVE.
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:07740-1436
Practice Address - Country:US
Practice Address - Phone:516-354-0990
Practice Address - Fax:516-354-2838
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111932207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery