Healthcare Provider Details

I. General information

NPI: 1144458761
Provider Name (Legal Business Name): LESLIE ANN MILANO-LUONGO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 MOUNT BELVEDERE BLVD USA MEDDAC/CREDENTIALS
FORT DRUM NY
13602-5438
US

IV. Provider business mailing address

11050 MOUNT BELVEDERE BLVD USA MEDDAC ATTN: CREDENTIALS
FORT DRUM NY
13602-5438
US

V. Phone/Fax

Practice location:
  • Phone: 315-772-4025
  • Fax: 315-772-9498
Mailing address:
  • Phone: 315-772-4025
  • Fax: 315-772-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number006183-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: