Healthcare Provider Details

I. General information

NPI: 1073019584
Provider Name (Legal Business Name): LEONARD A HAAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MARCUS AVE STE 201
NEW HYDE PARK NY
11042-1113
US

IV. Provider business mailing address

2800 MARCUS AVE STE 201
NEW HYDE PARK NY
11042-1113
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-6076
  • Fax: 470-275-0726
Mailing address:
  • Phone: 516-622-6076
  • Fax: 470-275-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberD91137
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: