Provider Demographics
NPI:1649275280
Name:LEIDNER, SHELDON D (MD)
Entity type:Individual
Prefix:
First Name:SHELDON
Middle Name:D
Last Name:LEIDNER
Suffix:
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 1:111 MALTESE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2115
Mailing Address - Country:US
Mailing Address - Phone:845-342-5199
Mailing Address - Fax:845-343-8741
Practice Address - Street 1:518 BROADWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1157
Practice Address - Country:US
Practice Address - Phone:845-794-1600
Practice Address - Fax:845-794-0749
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116318207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY116318-1OtherLICENSE
AL563605OtherDEA
NY116318-1OtherLICENSE
NY313861Medicare PIN