Provider Demographics
NPI:1720389133
Name:TANNOUS, LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:TANNOUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1190 5TH AVE # 1028
Mailing Address - Street 2:DEPARTMENT OF CARDIOTHORACIC SURGERY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6503
Mailing Address - Country:US
Mailing Address - Phone:212-659-6800
Mailing Address - Fax:212-659-6818
Practice Address - Street 1:1190 5TH AVE # 1028
Practice Address - Street 2:DEPARTMENT OF CARDIOTHORACIC SURGERY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6503
Practice Address - Country:US
Practice Address - Phone:212-659-6800
Practice Address - Fax:212-659-6818
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011252-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant