Provider Demographics
NPI:1801032081
Name:LEON, GERMAN COTA (LPN)
Entity Type:Individual
Prefix:
First Name:GERMAN
Middle Name:COTA
Last Name:LEON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 21ST ST APT 6J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3136
Mailing Address - Country:US
Mailing Address - Phone:212-924-4649
Mailing Address - Fax:
Practice Address - Street 1:3240 201ST ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1016
Practice Address - Country:US
Practice Address - Phone:718-428-6178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00294852164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112689787Medicaid