Provider Demographics
NPI:1922300615
Name:LEON, ROBERTA E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:E
Last Name:LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 KEW GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1100
Mailing Address - Country:US
Mailing Address - Phone:718-268-9059
Mailing Address - Fax:718-261-0134
Practice Address - Street 1:47 KEW GARDENS RD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1100
Practice Address - Country:US
Practice Address - Phone:718-268-9059
Practice Address - Fax:718-261-0134
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141699174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist