Provider Demographics
NPI:1659343960
Name:TUMANOV, LEONID (MD)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:TUMANOV
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:PO BOX 11706
Mailing Address - Street 2:NEW ENGLAND LASER AND COSMETIC SURGERY CENTER
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-0706
Mailing Address - Country:US
Mailing Address - Phone:518-389-1803
Mailing Address - Fax:518-389-1788
Practice Address - Street 1:1210 TROY SCHENECTADY RD
Practice Address - Street 2:NELSC
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1027
Practice Address - Country:US
Practice Address - Phone:518-783-0035
Practice Address - Fax:518-786-1160
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200395207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G55206Medicare UPIN