Provider Demographics
NPI:1881644326
Name:LEADON, JOSEPH G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:LEADON
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 1:7107 SUTTON PLACE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:718-380-2418
Mailing Address - Fax:718-535-7999
Practice Address - Street 1:7107 SUTTON PLACE, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:718-380-2418
Practice Address - Fax:718-535-7999
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169355-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01833141Medicaid
NY624852Medicare ID - Type Unspecified
NYF44965Medicare UPIN