Provider Demographics
NPI:1255721577
Name:LEOCUMOVICH, OLEG (MS)
Entity type:Individual
Prefix:MR
First Name:OLEG
Middle Name:
Last Name:LEOCUMOVICH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 GRAVESEND NECK RD
Mailing Address - Street 2:APT. 5L.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 GRAVESEND NECK RD
Practice Address - Street 2:APT. 5L.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4256
Practice Address - Country:US
Practice Address - Phone:646-667-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY803238131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist