Provider Demographics
NPI:1700090149
Name:SISKIN, LEAH PEARL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:PEARL
Last Name:SISKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 MARINO AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4208
Mailing Address - Country:US
Mailing Address - Phone:516-883-3361
Mailing Address - Fax:718-962-7712
Practice Address - Street 1:7559 263RD ST
Practice Address - Street 2:AMBULATORY CARE PAVILION
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1150
Practice Address - Country:US
Practice Address - Phone:718-470-4696
Practice Address - Fax:718-962-7712
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013566-1103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging