Provider Demographics
NPI:1760870869
Name:RAVIV, LEIGH S (NP)
Entity Type:Individual
Prefix:MS
First Name:LEIGH
Middle Name:S
Last Name:RAVIV
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4325
Mailing Address - Country:US
Mailing Address - Phone:212-532-1111
Mailing Address - Fax:
Practice Address - Street 1:185 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4325
Practice Address - Country:US
Practice Address - Phone:212-532-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-26
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 653205163W00000X
NY42 421182363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse