MEDICARE: JACKIE LEONG M.D.

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	2085B0100X	Body Imaging Physician	25MA05941500	NJ
2	2085N0904X	Nuclear Radiology Physician	25MA05941500	NJ
3	2085R0202X	Diagnostic Radiology Physician	25MA05941500	NJ
4	2085U0001X	Diagnostic Ultrasound Physician	25MA05941500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629170782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE LEONG M.D.

Provider Business Mailing Address
First Line	:	1419 35TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3727
Country	:	US
Telephone Number	:	914-747-2438
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 35TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3727
Country	:	US
Telephone Number	:	914-747-2438
Fax Number	:

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	09/11/2025

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