Healthcare Provider Details

I. General information

NPI: 1245289040
Provider Name (Legal Business Name): TINA ANNE LEONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST PH 17W-302
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST PH 17W-302
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-8500
  • Fax:
Mailing address:
  • Phone: 212-305-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number266902
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number266902
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: