Healthcare Provider Details

I. General information

NPI: 1962600213
Provider Name (Legal Business Name): LEON ALEKSANDROVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2007
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 EAST TREMONT AVENUE
BRONX NY
10460
US

IV. Provider business mailing address

930 EAST TREMONT AVENUE
BRONX NY
10460
US

V. Phone/Fax

Practice location:
  • Phone: 718-860-1111
  • Fax: 646-224-1320
Mailing address:
  • Phone: 718-860-1111
  • Fax: 646-224-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number245002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: