Healthcare Provider Details

I. General information

NPI: 1104534197
Provider Name (Legal Business Name): LINDSEY ANN LEOPOLD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 WHEELER RD
CENTRAL ISLIP NY
11722-2026
US

IV. Provider business mailing address

1 BROADWAY AVE
CENTRAL ISLIP NY
11722-2436
US

V. Phone/Fax

Practice location:
  • Phone: 631-348-5000
  • Fax: 631-348-4582
Mailing address:
  • Phone: 631-348-5041
  • Fax: 631-348-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number752822
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: