MEDICARE: PHILIP LEO MD

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	207Q00000X	Family Medicine Physician	146569	NY

General Provider Information

NPI Number	:	1184619371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP LEO MD

Provider Business Mailing Address
First Line	:	11 RALPH PL
Second Line	:	SUITE 213
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4419
Country	:	US
Telephone Number	:	718-556-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 RALPH PL
Second Line	:	SUITE 213
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4419
Country	:	US
Telephone Number	:	718-556-9400
Fax Number	:

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	12/23/2012

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Directions to “ PHILIP LEO MD” Practice Location

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