Provider Demographics
NPI:1952448797
Name:LEITMAN, JEFFREY (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:LEITMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 86TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1062
Mailing Address - Country:US
Mailing Address - Phone:212-427-2000
Mailing Address - Fax:212-427-2008
Practice Address - Street 1:120 E 86TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1062
Practice Address - Country:US
Practice Address - Phone:212-427-2000
Practice Address - Fax:212-427-2008
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB31922207Q00000X
NY247228-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE79633Medicare UPIN
NJ139335A4KMedicare PIN