Healthcare Provider Details

I. General information

NPI: 1356500417
Provider Name (Legal Business Name): MRS. CECILE MARIE LEBLANC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68-80 SCHERMERHORN STREET
BROOKLYN NY
11201
US

IV. Provider business mailing address

663 FLANDERS DR
NO WOODMERE NY
11581
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-7200
  • Fax:
Mailing address:
  • Phone: 516-295-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number212143
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: