Healthcare Provider Details

I. General information

NPI: 1093140436
Provider Name (Legal Business Name): ANTHONY M. LEONE, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 PARK CLUB LN SUITE 120
WILLIAMSVILLE NY
14221-5270
US

IV. Provider business mailing address

192 PARK CLUB LN SUITE 120
WILLIAMSVILLE NY
14221-5270
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-1101
  • Fax:
Mailing address:
  • Phone: 716-204-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number199038
License Number StateNY

VIII. Authorized Official

Name: ANTHONY M LEONE
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 716-204-1101