Healthcare Provider Details

I. General information

NPI: 1295991867
Provider Name (Legal Business Name): TONY LEUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HIGHLAND AVE SURGICAL SERVICES
SOMERVILLE MA
02143-1408
US

IV. Provider business mailing address

230 HIGHLAND AVE SURGICAL SERVICES
SOMERVILLE MA
02143-1408
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-2555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number267793-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number267793-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: