Healthcare Provider Details

I. General information

NPI: 1013745496
Provider Name (Legal Business Name): LEESA JAYESH PARIKH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 PARK AVE STE E
NEW YORK NY
10128-1209
US

IV. Provider business mailing address

300 E 93RD ST APT 34C
NEW YORK NY
10128-6110
US

V. Phone/Fax

Practice location:
  • Phone: 212-360-6500
  • Fax: 212-360-6535
Mailing address:
  • Phone: 408-805-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: