Healthcare Provider Details

I. General information

NPI: 1912081738
Provider Name (Legal Business Name): LEROY FAMILY MEDICAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 TOUNTAS AVE SUITE 1
LE ROY NY
14482-1368
US

IV. Provider business mailing address

3 TOUNTAS AVE SUITE 1
LE ROY NY
14482-1368
US

V. Phone/Fax

Practice location:
  • Phone: 585-768-4400
  • Fax: 585-768-7792
Mailing address:
  • Phone: 585-768-4400
  • Fax: 585-768-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2051631
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300952
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3328321
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2051631
License Number StateNY

VIII. Authorized Official

Name: JAMIE SCHWARTZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 585-768-5330