Healthcare Provider Details

I. General information

NPI: 1942902010
Provider Name (Legal Business Name): LEYDRICAH SAINT LOUIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DUBOIS ST
NEWBURGH NY
12550-4851
US

IV. Provider business mailing address

70 DUBOIS ST
NEWBURGH NY
12550-4851
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-4400
  • Fax:
Mailing address:
  • Phone: 516-562-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number334159
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: