Healthcare Provider Details

I. General information

NPI: 1184877508
Provider Name (Legal Business Name): LEON ZACHAROWICZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PRESIDENTIAL PLZ 4TH FLOOR
SYRACUSE NY
13202-2240
US

IV. Provider business mailing address

90 PRESIDENTIAL PLZ 4TH FLOOR
SYRACUSE NY
13202-2240
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4243
  • Fax: 315-464-5350
Mailing address:
  • Phone: 315-464-4243
  • Fax: 315-464-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number182176
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number182176
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01772090
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: