Provider Demographics
NPI:1467783936
Name:LEONICHEV, VICTORIA BORISIVNA (DO)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:BORISIVNA
Last Name:LEONICHEV
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MAPLE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4707
Mailing Address - Country:US
Mailing Address - Phone:818-624-0083
Mailing Address - Fax:818-760-0882
Practice Address - Street 1:170 MAPLE AVE STE 104
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4707
Practice Address - Country:US
Practice Address - Phone:914-328-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-23
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294476207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease