Healthcare Provider Details

I. General information

NPI: 1942475868
Provider Name (Legal Business Name): SAM A. LEUZZI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 CROMWELL AVE SUITE B
STATEN ISLAND NY
10304-3933
US

IV. Provider business mailing address

78 CROMWELL AVE SUITE B
STATEN ISLAND NY
10304-3933
US

V. Phone/Fax

Practice location:
  • Phone: 718-979-7900
  • Fax: 718-979-8500
Mailing address:
  • Phone: 718-979-7900
  • Fax: 718-979-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number185975
License Number StateNY

VIII. Authorized Official

Name: DR. SAM LEUZZI
Title or Position: PRESIDENT
Credential:
Phone: 718-979-7900