Provider Demographics
NPI:1942631684
Name:WILKINS, LEOPOLD MONTGOMERY (PHD)
Entity Type:Individual
Prefix:MR
First Name:LEOPOLD
Middle Name:MONTGOMERY
Last Name:WILKINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10034 210TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1045
Mailing Address - Country:US
Mailing Address - Phone:718-776-7700
Mailing Address - Fax:718-776-7701
Practice Address - Street 1:10034 210TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-1045
Practice Address - Country:US
Practice Address - Phone:718-776-7700
Practice Address - Fax:718-776-7701
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1478L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health