Healthcare Provider Details

I. General information

NPI: 1205578168
Provider Name (Legal Business Name): LAUREEN JEAN LEYDEN RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 02/17/2024
Certification Date: 02/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COLUMBUS CIR FL 15
NEW YORK NY
10019-8716
US

IV. Provider business mailing address

1178 BROADWAY 3RD FLOOR #3252
NEW YORK NY
10001
US

V. Phone/Fax

Practice location:
  • Phone: 347-201-0783
  • Fax:
Mailing address:
  • Phone: 347-201-0783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number011023
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: