Provider Demographics
NPI:1780796045
Name:CITROME, LESLIE LUCIEN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:LUCIEN
Last Name:CITROME
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BLUE SKY DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-2307
Mailing Address - Country:US
Mailing Address - Phone:845-398-5595
Mailing Address - Fax:
Practice Address - Street 1:11 MEDICAL PARK DR
Practice Address - Street 2:SUITE 106
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3559
Practice Address - Country:US
Practice Address - Phone:845-398-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1709472084P0800X
NJ25MA047809002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry