Healthcare Provider Details

I. General information

NPI: 1275790800
Provider Name (Legal Business Name): TIMOTHY LEUNG DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 CENTRAL PARK AVENUE SUITE 207
SCARSDALE NY
10583
US

IV. Provider business mailing address

1075 CENTRAL PARK AVENUE SUITE 207
SCARSDALE NY
10583
US

V. Phone/Fax

Practice location:
  • Phone: 914-472-5252
  • Fax: 914-722-5987
Mailing address:
  • Phone: 914-472-5252
  • Fax: 914-722-5987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number052693
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number50-052693
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: