Healthcare Provider Details

I. General information

NPI: 1346528924
Provider Name (Legal Business Name): ALBERTO BORDONABA LEIVA DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. ALBERTO BORDONABA LEIVA

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 WATER ST APT M1
NEW YORK NY
10038-1760
US

IV. Provider business mailing address

264 WATER ST APT M1
NEW YORK NY
10038-1760
US

V. Phone/Fax

Practice location:
  • Phone: 585-764-9006
  • Fax:
Mailing address:
  • Phone: 585-764-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number059099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: