Provider Demographics
NPI:1942475868
Name:SAM A. LEUZZI
Entity Type:Organization
Organization Name:SAM A. LEUZZI
Other - Org Name:CROMWELL PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-979-7900
Mailing Address - Street 1:78 CROMWELL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3933
Mailing Address - Country:US
Mailing Address - Phone:718-979-7900
Mailing Address - Fax:718-979-8500
Practice Address - Street 1:78 CROMWELL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3933
Practice Address - Country:US
Practice Address - Phone:718-979-7900
Practice Address - Fax:718-979-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1859752080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01265030Medicaid