Healthcare Provider Details

I. General information

NPI: 1396705729
Provider Name (Legal Business Name): LEENA PHILIP M.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: LEENA THOMAS M.D.

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1872 COMMERCE ST
YORKTOWN HEIGHTS NY
10598-4430
US

IV. Provider business mailing address

1872 COMMERCE ST
YORKTOWN HEIGHTS NY
10598-4430
US

V. Phone/Fax

Practice location:
  • Phone: 914-962-3303
  • Fax: 914-962-4271
Mailing address:
  • Phone: 914-962-3303
  • Fax: 914-962-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number225325
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: