Healthcare Provider Details

I. General information

NPI: 1316408008
Provider Name (Legal Business Name): ANDREA LEYTON-MANGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST FL 6
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

5 E 98TH ST FL 6
NEW YORK NY
10029-6501
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6321
  • Fax:
Mailing address:
  • Phone: 212-241-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number328869
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: