Healthcare Provider Details

I. General information

NPI: 1144225350
Provider Name (Legal Business Name): GABRIEL T LEONTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-3000
  • Fax: 631-224-8560
Mailing address:
  • Phone: 631-376-3000
  • Fax: 631-376-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number227501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: