=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154352987
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEONARD BIELORY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 05/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 MOUNTAIN AVE
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07081-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-912-9817
-----------------------------------------------------
Fax | 206-333-1884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 MOUNTAIN AVE
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07081-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-912-9817
-----------------------------------------------------
Fax | 206-333-1884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207KI0005X
-----------------------------------------------------
Taxonomy Name | Clinical & Laboratory Immunology (Allergy & Immunology) Physician
-----------------------------------------------------
License Number | 25MA04594700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------