Healthcare Provider Details

I. General information

NPI: 1326770900
Provider Name (Legal Business Name): LESLIE GONZALEZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER RD
BRONX NY
10461-2301
US

IV. Provider business mailing address

2413 3RD AVE APT 801
BRONX NY
10451-1988
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-2000
  • Fax:
Mailing address:
  • Phone: 818-571-3607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number125.081038
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: