Healthcare Provider Details

I. General information

NPI: 1447371836
Provider Name (Legal Business Name): LEAH VIOLAGO CPNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

545 W 100TH ST 4E
NEW YORK NY
10025
US

V. Phone/Fax

Practice location:
  • Phone: 917-445-6036
  • Fax:
Mailing address:
  • Phone: 917-445-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberF381501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: