Provider Demographics
NPI:1720198252
Name:LESLIE, SCOTT DAVID (DC, ATC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:LESLIE
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 FROWEIN RD
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2006
Mailing Address - Country:US
Mailing Address - Phone:631-909-8369
Mailing Address - Fax:
Practice Address - Street 1:50 PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1708
Practice Address - Country:US
Practice Address - Phone:631-422-4234
Practice Address - Fax:631-422-4243
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008445111N00000X
NY000691-22255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU68569Medicare UPIN
NYX99002Medicare ID - Type Unspecified