Healthcare Provider Details

I. General information

NPI: 1003084138
Provider Name (Legal Business Name): ANGELA MARIE LEO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MARIE LEO-NIEBERG DO

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CHURCH ST FL 2
NEW YORK NY
10013-2442
US

IV. Provider business mailing address

315 CHURCH ST FL 2
NEW YORK NY
10013-2442
US

V. Phone/Fax

Practice location:
  • Phone: 212-334-3774
  • Fax:
Mailing address:
  • Phone: 212-334-3774
  • Fax: 212-320-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number251544-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: