Healthcare Provider Details

I. General information

NPI: 1720074941
Provider Name (Legal Business Name): JOSHUA DELEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 JERICHO TPKE
MINEOLA NY
11501-1613
US

IV. Provider business mailing address

212 JERICHO TPKE
MINEOLA NY
11501-1613
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-4480
  • Fax: 516-663-2054
Mailing address:
  • Phone: 516-663-4480
  • Fax: 516-663-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number179286
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number179286
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: