Healthcare Provider Details

I. General information

NPI: 1114859113
Provider Name (Legal Business Name): LEORAH LALEZARI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 BATHGATE AVE
BRONX NY
10457-6283
US

IV. Provider business mailing address

827 S HOLT AVE
LOS ANGELES CA
90035-1806
US

V. Phone/Fax

Practice location:
  • Phone: 718-466-3580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030905
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: