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General NPI Number Information
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NPI Number | 1225068372
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Entity Type | Individual
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Provider Name | MARIO MENDES LEITAO JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 1275 YORK AVE # H1314
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City | NEW YORK
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State | NY
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Zip | 10065-6007
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Country | US
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Telephone | 212-639-3987
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Fax | 212-717-3709
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Provider Business Mailing Address
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Address Line | 1275 YORK AVE # H1314
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City | NEW YORK
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State | NY
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Zip | 10065-6007
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Country | US
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Telephone | 646-620-2438
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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 | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 25MA07727200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 208249
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License Number State | NY
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