Healthcare Provider Details

I. General information

NPI: 1477895167
Provider Name (Legal Business Name): BRIDGET ANNE LEONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 09/06/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 N BELLE MEAD RD STE 5AND6
EAST SETAUKET NY
11733-3495
US

IV. Provider business mailing address

181 N BELLE MEAD RD STE 5AND6
EAST SETAUKET NY
11733-3495
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number279709
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number25MA10611500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number279709
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: