Healthcare Provider Details

I. General information

NPI: 1053636183
Provider Name (Legal Business Name): RACHELLE LEONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 N FULLERTON AVE STE 2
MONTCLAIR NJ
07042-3446
US

IV. Provider business mailing address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

V. Phone/Fax

Practice location:
  • Phone: 973-509-1818
  • Fax: 973-509-0708
Mailing address:
  • Phone: 516-684-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25MA09968600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: