Healthcare Provider Details

I. General information

NPI: 1629170782
Provider Name (Legal Business Name): JACKIE LEONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 35TH ST
BROOKLYN NY
11218-3727
US

IV. Provider business mailing address

1419 35TH ST
BROOKLYN NY
11218-3727
US

V. Phone/Fax

Practice location:
  • Phone: 914-747-2438
  • Fax:
Mailing address:
  • Phone: 914-747-2438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number25MA05941500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number25MA05941500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA05941500
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number25MA05941500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: