Healthcare Provider Details

I. General information

NPI: 1093102022
Provider Name (Legal Business Name): LEAH DICKSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH GERSHEN MD

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

100 HARBORVIEW DR UNIT 1510
BALTIMORE MD
21230-5415
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7300
  • Fax:
Mailing address:
  • Phone: 201-280-9720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberA161457
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01084757A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: