Healthcare Provider Details

I. General information

NPI: 1104065408
Provider Name (Legal Business Name): SEAN LEECHONG LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 NORTHERN BLVD
LONG ISLAND CITY NY
11101-3635
US

IV. Provider business mailing address

2959 NORTHERN BLVD APT 24F
LONG ISLAND CITY NY
11101-3650
US

V. Phone/Fax

Practice location:
  • Phone: 917-971-8125
  • Fax:
Mailing address:
  • Phone: 917-971-8125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number011824
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: