Healthcare Provider Details

I. General information

NPI: 1245213131
Provider Name (Legal Business Name): ROBERT C LEAHY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 WAVERLY AVE SUITE 13
HOLTSVILLE NY
11742-1128
US

IV. Provider business mailing address

1018 WAVERLY AVE SUITE13
HOLTSVILLE NY
11742-1128
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-7900
  • Fax: 631-654-7972
Mailing address:
  • Phone: 631-654-7900
  • Fax: 631-654-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX0065433
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: