Provider Demographics
NPI:1851813117
Name:GEOGHEGAN, LEAH MARY (AGNP-C IFMCP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARY
Last Name:GEOGHEGAN
Suffix:
Gender:F
Credentials:AGNP-C IFMCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 FIFTH AVE
Mailing Address - Street 2:SUITE 1402-342
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5034
Mailing Address - Country:US
Mailing Address - Phone:646-849-2782
Mailing Address - Fax:646-349-0133
Practice Address - Street 1:347 FIFTH AVE
Practice Address - Street 2:SUITE 1402-342
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5034
Practice Address - Country:US
Practice Address - Phone:646-849-2782
Practice Address - Fax:646-349-0133
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308726363LG0600X
PARN738747163WH0200X
CT11894363L00000X
PASP023435363LG0600X
CT207439163W00000X
NY688126163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency