Provider Demographics
NPI:1962494591
Name:LEON, JOSE S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:S
Last Name:LEON
Suffix:JR
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 1:108 SCUDDER PL
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3025
Mailing Address - Country:US
Mailing Address - Phone:631-757-0826
Mailing Address - Fax:
Practice Address - Street 1:108 SCUDDER PL
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3025
Practice Address - Country:US
Practice Address - Phone:631-757-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205929207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G84672Medicare UPIN
46C851Medicare ID - Type Unspecified