Provider Demographics
NPI:1013626761
Name:LEIGH NATHAN, MD PLLC
Entity Type:Organization
Organization Name:LEIGH NATHAN, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-222-0828
Mailing Address - Street 1:14 BOWER RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2526
Mailing Address - Country:US
Mailing Address - Phone:860-222-0828
Mailing Address - Fax:
Practice Address - Street 1:85B WALL STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3121
Practice Address - Country:US
Practice Address - Phone:860-222-0828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health