MEDICARE: DR. MARC A LEAF 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	207RG0100X	Gastroenterology Physician	151457	NY
2	207R00000X	Internal Medicine Physician	151457	NY

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
2	059AD1	OTHER	NY	EMPIRE BCBS

General Provider Information

NPI Number	:	1700988797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC A LEAF MD

Provider Business Mailing Address
First Line	:	8023 19TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214
Country	:	US
Telephone Number	:	718-259-7700
Fax Number	:	718-232-5445

Provider Business Practice Location Address
First Line	:	8023 19TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1753
Country	:	US
Telephone Number	:	718-232-3003
Fax Number	:	718-232-5445

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	03/14/2011

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