Healthcare Provider Details

I. General information

NPI: 1093609406
Provider Name (Legal Business Name): CHRISTIAN Y. DE LEON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WATERS PL
BRONX NY
10461-2714
US

IV. Provider business mailing address

91 VALLEY WAY
WEST ORANGE NJ
07052-5828
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-3600
  • Fax:
Mailing address:
  • Phone: 718-801-2748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number8073912
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number807392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: