Healthcare Provider Details

I. General information

NPI: 1659763894
Provider Name (Legal Business Name): MR. LEONARD BARRETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 01 JAMAICA AV.
QUEENS NY
11422
US

IV. Provider business mailing address

253 35 149 DR.
ROSEDALE NY
11422
US

V. Phone/Fax

Practice location:
  • Phone: 347-613-3981
  • Fax:
Mailing address:
  • Phone: 347-613-3981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: