Healthcare Provider Details

I. General information

NPI: 1346502374
Provider Name (Legal Business Name): MRS. LESLIE M. NATHANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 HOFSTRA DR
PLAINVIEW NY
11803-1841
US

IV. Provider business mailing address

48 HOFSTRA DR
PLAINVIEW NY
11803-1841
US

V. Phone/Fax

Practice location:
  • Phone: 516-367-3144
  • Fax: 516-224-4306
Mailing address:
  • Phone: 516-367-3144
  • Fax: 516-224-4306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number645E21859
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: