Healthcare Provider Details

I. General information

NPI: 1225007271
Provider Name (Legal Business Name): LEONARDO VANDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W 145TH ST
NEW YORK NY
10031-5101
US

IV. Provider business mailing address

507 W 145 TH STREET
NEW YORK NY
10031
US

V. Phone/Fax

Practice location:
  • Phone: 646-373-2753
  • Fax: 212-582-0888
Mailing address:
  • Phone: 646-373-2753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0092757
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA11148000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number25MA11148000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number237586
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberD0092757
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2375861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: