Provider Demographics
NPI:1982701066
Name:LEICHMAN, GERALD (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:LEICHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-6403
Mailing Address - Country:US
Mailing Address - Phone:516-622-1842
Mailing Address - Fax:
Practice Address - Street 1:355 W 52ND ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6239
Practice Address - Country:US
Practice Address - Phone:212-778-5555
Practice Address - Fax:646-778-5548
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY43162POtherHIP
NYLG5586OtherATLANTIS
NY1355866OtherWORKER COMP
NY00636044Medicaid
NY18A171OtherBCBS
NY20642867OtherBEECHSTREET
NY57185592OtherMULTIPLAN
NY907781-18OtherUHC
NYNP767OtherOXFORD
NY5997182OtherGHI
NY2894721-135238OtherAETNA
NY2C3426OtherHEALTHNET
NYLG5586OtherATLANTIS
NYB10522Medicare UPIN