Provider Demographics
NPI:1740254846
Name:LESLIE, CYNTHIA LYNN (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:LESLIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1154
Mailing Address - Country:US
Mailing Address - Phone:845-483-5851
Mailing Address - Fax:845-483-5807
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1361
Practice Address - Country:US
Practice Address - Phone:845-483-5851
Practice Address - Fax:845-483-5807
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226078-12086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02325368Medicaid
NY02325368Medicaid
NYG62841Medicare UPIN