Provider Demographics
NPI:1750622239
Name:DUNN-LEA MEDICAL PC
Entity type:Organization
Organization Name:DUNN-LEA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNNDER LEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-204-1469
Mailing Address - Street 1:440 E 20TH ST
Mailing Address - Street 2:9B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8208
Mailing Address - Country:US
Mailing Address - Phone:718-204-1469
Mailing Address - Fax:718-545-1726
Practice Address - Street 1:3096 51ST ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1457
Practice Address - Country:US
Practice Address - Phone:718-204-1469
Practice Address - Fax:718-545-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty