Healthcare Provider Details

I. General information

NPI: 1841261641
Provider Name (Legal Business Name): MARIO LECUONA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 STEUBEN ST
MONTOUR FALLS NY
14865-9648
US

IV. Provider business mailing address

230 STEUBEN ST
MONTOUR FALLS NY
14865-9648
US

V. Phone/Fax

Practice location:
  • Phone: 607-210-1968
  • Fax: 607-210-1971
Mailing address:
  • Phone: 607-210-1968
  • Fax: 607-210-1971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number103540-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: