Healthcare Provider Details

I. General information

NPI: 1285601963
Provider Name (Legal Business Name): ALFRED B LEONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SIXTH STREET
BROOKLYN NY
11215
US

IV. Provider business mailing address

515 SIXTH STREET
BROOKLYN NY
11215
US

V. Phone/Fax

Practice location:
  • Phone: 718-246-8600
  • Fax: 718-246-8601
Mailing address:
  • Phone: 718-246-8600
  • Fax: 718-246-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number197629
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number197629
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: