MEDICARE: AMY LEUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1053164715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LEUNG

Provider Business Mailing Address
First Line	:	1832 64TH ST APT D3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2911
Country	:	US
Telephone Number	:	646-637-7602
Fax Number	:

Provider Business Practice Location Address
First Line	:	5805 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3964
Country	:	US
Telephone Number	:	718-439-8816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	04/10/2024

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