Healthcare Provider Details

I. General information

NPI: 1700378593
Provider Name (Legal Business Name): NATA LEYBENGRUB PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2276 MERRICK AVE
MERRICK NY
11566-4342
US

IV. Provider business mailing address

2276 MERRICK AVE
MERRICK NY
11566-4342
US

V. Phone/Fax

Practice location:
  • Phone: 516-712-6565
  • Fax: 516-217-4049
Mailing address:
  • Phone: 516-712-6565
  • Fax: 516-217-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number022035-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: