Provider Demographics
NPI:1720324353
Name:BRADY, LESLIE FOLKS (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:FOLKS
Last Name:BRADY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:LOUISE
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:17 E 102ND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5204
Mailing Address - Country:US
Mailing Address - Phone:212-241-7968
Mailing Address - Fax:212-824-2312
Practice Address - Street 1:17 E 102ND ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5204
Practice Address - Country:US
Practice Address - Phone:212-241-7968
Practice Address - Fax:212-824-2312
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010018364SA2200X
NYF305800-1364SA2200X
NYF305800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health