Healthcare Provider Details

I. General information

NPI: 1528638780
Provider Name (Legal Business Name): CHI TU TRUONG-LEISNER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date: 06/06/2022
Reactivation Date: 07/15/2022

III. Provider practice location address

619 FULTON AVE
HEMPSTEAD NY
11550-4553
US

IV. Provider business mailing address

857 S OYSTER BAY RD
BETHPAGE NY
11714-1030
US

V. Phone/Fax

Practice location:
  • Phone: 516-571-1300
  • Fax: 516-572-1741
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403977
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: