Healthcare Provider Details

I. General information

NPI: 1124000310
Provider Name (Legal Business Name): LESLIE BANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MITCHELL AVE
BINGHAMTON NY
13903
US

IV. Provider business mailing address

40 MITCHELL AVE.
BINGHAMTON NY
13903
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-0639
  • Fax:
Mailing address:
  • Phone: 607-772-0639
  • Fax: 607-772-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number173774
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number173774
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: