Healthcare Provider Details

I. General information

NPI: 1386220671
Provider Name (Legal Business Name): LEIGH ETTINGER, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 MAIN ST STE 203
NEW PALTZ NY
12561-1116
US

IV. Provider business mailing address

153 MAIN ST STE 203
NEW PALTZ NY
12561-1116
US

V. Phone/Fax

Practice location:
  • Phone: 845-475-8116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LEIGH ETTINGER
Title or Position: OWNER
Credential: MD
Phone: 917-838-5457