Provider Demographics
NPI:1851486088
Name:IZRAYELIT, LEONID (MD)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:IZRAYELIT
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 1:5746 226TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2045
Mailing Address - Country:US
Mailing Address - Phone:718-261-3577
Mailing Address - Fax:718-261-4142
Practice Address - Street 1:11215 72ND RD
Practice Address - Street 2:SUITE LL1
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4663
Practice Address - Country:US
Practice Address - Phone:718-261-3577
Practice Address - Fax:718-261-4142
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2073972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG62662Medicare UPIN
NY06275Medicare PIN