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General NPI Number Information
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NPI Number | 1275768327
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Entity Type | Organization
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Legal Business Name | VR LEDDY, M.D., P.C.
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 160 FOURTH STREET
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City | BRENTWOOD
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State | NY
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Zip | 11717
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Country | US
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Telephone | 631-273-7105
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Fax | 631-273-7253
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Provider Business Mailing Address
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Address Line | 160 FOURTH STREET
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City | BRENTWOOD
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State | NY
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Zip | 11717
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Country | US
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Telephone | 631-273-7105
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Fax | 631-273-7253
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VINCENT RICHARD LEDDY
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Credential | M.D.
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Telephone | 631-273-7105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 152061
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License Number State | NY
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