Provider Demographics
NPI:1881939205
Name:TWENA, LEORA (PA)
Entity type:Individual
Prefix:
First Name:LEORA
Middle Name:
Last Name:TWENA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 E 14TH ST
Mailing Address - Street 2:NYU LANGONE BROOKLYN GASTROENEROLOGY ASSOCIATES
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1104
Mailing Address - Country:US
Mailing Address - Phone:718-336-9100
Mailing Address - Fax:
Practice Address - Street 1:1630 E 14TH ST
Practice Address - Street 2:NYU LANGONE BROOKLYN GASTROENTEROLOGY ASSOCIATES
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1104
Practice Address - Country:US
Practice Address - Phone:718-336-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15638-1363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical