Provider Demographics
NPI:1881612760
Name:TAMMY LEOPOLD MD PLLC
Entity type:Organization
Organization Name:TAMMY LEOPOLD MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEOPOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-397-5140
Mailing Address - Street 1:PO BOX 20295
Mailing Address - Street 2:COLUMBUS CIRCLE STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-397-5140
Mailing Address - Fax:212-397-0451
Practice Address - Street 1:408 W 57TH ST
Practice Address - Street 2:SUITE 1L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3053
Practice Address - Country:US
Practice Address - Phone:212-397-5140
Practice Address - Fax:212-397-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H44799Medicare UPIN
WDW661Medicare ID - Type Unspecified