Healthcare Provider Details

I. General information

NPI: 1043126451
Provider Name (Legal Business Name): LEONEL PAUL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 E MAIN ST
OYSTER BAY NY
11771-2440
US

IV. Provider business mailing address

9 E MAIN ST
OYSTER BAY NY
11771-2440
US

V. Phone/Fax

Practice location:
  • Phone: 516-864-2900
  • Fax: 516-864-2902
Mailing address:
  • Phone: 516-864-2900
  • Fax: 516-864-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: