Healthcare Provider Details

I. General information

NPI: 1083138168
Provider Name (Legal Business Name): LEAH ESTHER LAX PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GRAND ST FL 2
NEW YORK NY
10002-4800
US

IV. Provider business mailing address

465 GRAND ST FL 2
NEW YORK NY
10002-4800
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-1970
  • Fax: 212-420-1910
Mailing address:
  • Phone: 212-420-1970
  • Fax: 212-420-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: