Provider Demographics
NPI:1700972619
Name:CECCARELLI, LEONARD GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:GERARD
Last Name:CECCARELLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:L
Other - Middle Name:GERARD
Other - Last Name:CECCARELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:253 PEACHTREE DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1121
Mailing Address - Country:US
Mailing Address - Phone:917-974-4610
Mailing Address - Fax:
Practice Address - Street 1:131 E 61ST ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8115
Practice Address - Country:US
Practice Address - Phone:212-588-1300
Practice Address - Fax:212-753-7968
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX8H301Medicare ID - Type Unspecified