Healthcare Provider Details

I. General information

NPI: 1932117959
Provider Name (Legal Business Name): EUGENE JOSEPH VAN LEEUWEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HIGHLAND AVE. SUITE E
CINCINNATI OH
45219-2315
US

IV. Provider business mailing address

3001 HIGHLAND AVE. SUITE E
CINCINNATI OH
45219-2315
US

V. Phone/Fax

Practice location:
  • Phone: 513-961-8861
  • Fax: 513-487-3770
Mailing address:
  • Phone: 513-961-8861
  • Fax: 513-487-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35055807
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35055807
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number35055807
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: