MEDICARE: LEANWELL

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1598614612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEANWELL

Provider Business Mailing Address
First Line	:	337 HAMPTON GRN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-1722
Country	:	US
Telephone Number	:	646-441-0626
Fax Number	:

Provider Business Practice Location Address
First Line	:	337 HAMPTON GRN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-1722
Country	:	US
Telephone Number	:	646-441-0626
Fax Number	:

Authorized Official
Title or Position	:	FNP-BC
Name	:	LARA TREGILLIES
Credential	:	NP
Telephone Number	:	646-872-0556

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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Directions to “LEANWELL ” Practice Location

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