Healthcare Provider Details

I. General information

NPI: 1215717111
Provider Name (Legal Business Name): LEOR EYLENKRIG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 AMBOY RD
STATEN ISLAND NY
10309-3109
US

IV. Provider business mailing address

581 JOHNSTON TER
STATEN ISLAND NY
10309-3954
US

V. Phone/Fax

Practice location:
  • Phone: 718-966-9278
  • Fax:
Mailing address:
  • Phone: 718-877-1229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number070844
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: