Healthcare Provider Details

I. General information

NPI: 1801143367
Provider Name (Legal Business Name): LINDSEY RAE LEINBACH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY RAE KATO FNP

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W 14TH ST STE 201
NEW YORK NY
10014
US

IV. Provider business mailing address

129 W 29TH ST FL 10
NEW YORK NY
10001-5105
US

V. Phone/Fax

Practice location:
  • Phone: 212-530-0639
  • Fax: 212-867-4353
Mailing address:
  • Phone: 415-658-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704260932
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number338176
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704260932
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338176
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: