Healthcare Provider Details

I. General information

NPI: 1154230563
Provider Name (Legal Business Name): LEONARDO JAVIER TERRONES-NUNEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

2 ATLANTIC PL
EAST NORTHPORT NY
11731-2837
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-0333
  • Fax:
Mailing address:
  • Phone: 631-974-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: