Healthcare Provider Details

I. General information

NPI: 1720324353
Provider Name (Legal Business Name): LESLIE FOLKS BRADY ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE LOUISE BRADY ANP-BC

II. Dates (important events)

Enumeration Date: 12/31/2012
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E 102ND ST FL 3
NEW YORK NY
10029-5204
US

IV. Provider business mailing address

17 E 102ND ST FL 3
NEW YORK NY
10029-5204
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-7968
  • Fax: 212-824-2312
Mailing address:
  • Phone: 212-241-7968
  • Fax: 212-824-2312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number209.010018
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberF305800-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305800
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: