Healthcare Provider Details

I. General information

NPI: 1124481494
Provider Name (Legal Business Name): ERIN LEOPOLDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2016
Last Update Date: 04/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6725 188TH ST
FRESH MEADOWS NY
11365-3767
US

IV. Provider business mailing address

4314 57TH ST
WOODSIDE NY
11377-4754
US

V. Phone/Fax

Practice location:
  • Phone: 718-454-6460
  • Fax:
Mailing address:
  • Phone: 516-672-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number963273151
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number963273151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: