Provider Demographics
NPI:1508865320
Name:DELEON, JOSE L (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:DELEON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:629 W 185TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3102
Mailing Address - Country:US
Mailing Address - Phone:212-928-3512
Mailing Address - Fax:212-927-2512
Practice Address - Street 1:629 W 185TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3102
Practice Address - Country:US
Practice Address - Phone:212-928-3512
Practice Address - Fax:212-927-2512
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN005544213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02131304Medicaid
NYPB4241Medicare ID - Type Unspecified
NY02131304Medicaid