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General NPI Number Information
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NPI Number | 1083780795
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Entity Type | Individual
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Provider Name | LEONID BILENKIN PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 55 HOLLY HILL LN 110
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City | GREENWICH
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State | CT
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Zip | 06830-6074
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Country | US
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Telephone | 203-863-4670
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Fax | 203-863-4674
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Provider Business Mailing Address
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Address Line | 16 GLEN DRIVE
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City | SOUTH SALEM
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State | NY
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Zip | 10590
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Country | US
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Telephone | 914-533-1182
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 003739
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 002258
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License Number State | CT
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