Healthcare Provider Details

I. General information

NPI: 1114264413
Provider Name (Legal Business Name): LEOPOLD JOHANN STRELETZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 10/22/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE STE 2112
HARTFORD CT
06105-1719
US

IV. Provider business mailing address

1000 ORIENTE AVE
GREENVILLE DE
19807-2261
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-3711
  • Fax: 860-493-7445
Mailing address:
  • Phone: 302-482-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01090963A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number01090963A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD012367E
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberEL31789
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: