Provider Demographics
NPI:1841282167
Name:DR DENIS LEBLANG DPM PC
Entity type:Organization
Organization Name:DR DENIS LEBLANG DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-939-4101
Mailing Address - Street 1:388 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3650
Mailing Address - Country:US
Mailing Address - Phone:914-939-4101
Mailing Address - Fax:914-939-4164
Practice Address - Street 1:388 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3650
Practice Address - Country:US
Practice Address - Phone:914-939-4101
Practice Address - Fax:914-939-4164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002957213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00497338Medicaid
NY1499432OtherGHI
NY00497338Medicaid
NY1499432OtherGHI
NYPXW212Medicare ID - Type Unspecified