Healthcare Provider Details

I. General information

NPI: 1366314734
Provider Name (Legal Business Name): LEAH T HEHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 HALLOCK AVE
PORT JEFFERSON STATION NY
11776-1217
US

IV. Provider business mailing address

46 BAYVIEW AVE
PORT WASHINGTON NY
11050-3532
US

V. Phone/Fax

Practice location:
  • Phone: 631-473-4284
  • Fax:
Mailing address:
  • Phone: 516-413-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1704700231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: