Healthcare Provider Details

I. General information

NPI: 1154632479
Provider Name (Legal Business Name): ANDREW LEO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 E MAIN ST STE 200
SMITHTOWN NY
11787-2916
US

IV. Provider business mailing address

290 E MAIN ST STE 200
SMITHTOWN NY
11787-2916
US

V. Phone/Fax

Practice location:
  • Phone: 631-361-5302
  • Fax: 631-361-8607
Mailing address:
  • Phone: 631-361-5302
  • Fax: 631-361-8607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW J LEO
Title or Position: MD
Credential: MD
Phone: 631-361-5302