Healthcare Provider Details

I. General information

NPI: 1306477302
Provider Name (Legal Business Name): LEO DREYFUSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N MOUNTAIN RD STE 300
PLAINVILLE CT
06062-1848
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC-CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-348-2500
  • Fax:
Mailing address:
  • Phone: 860-348-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number84609
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: