Healthcare Provider Details

I. General information

NPI: 1629406855
Provider Name (Legal Business Name): LEENA S VATTAPPALLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2013
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SOMERSET DR
PATTERSON NY
12563-2521
US

IV. Provider business mailing address

22 SOMERSET DR
PATTERSON NY
12563
US

V. Phone/Fax

Practice location:
  • Phone: 845-878-7210
  • Fax:
Mailing address:
  • Phone: 845-878-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberF33138
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: