Healthcare Provider Details

I. General information

NPI: 1396012258
Provider Name (Legal Business Name): MAIDEN LANE PODIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIDEN LN
NEW YORK NY
10038-4015
US

IV. Provider business mailing address

1 MAIDEN LN
NEW YORK NY
10038-4015
US

V. Phone/Fax

Practice location:
  • Phone: 212-608-7999
  • Fax: 212-812-3258
Mailing address:
  • Phone: 212-608-7999
  • Fax: 212-812-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003415
License Number StateNY

VIII. Authorized Official

Name: DR. JEROME BENJAMIN LEFF
Title or Position: DOCTOR
Credential: DPM
Phone: 212-608-7999