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General NPI Number Information
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NPI Number | 1316175052
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Entity Type | Individual
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Provider Name | KEVIN T LE ROY CFNP
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Gender | Male
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 110 W 6TH ST
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City | OSWEGO
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State | NY
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Zip | 13126-2507
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Country | US
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Telephone | 315-349-5511
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Fax | 315-349-5732
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Provider Business Mailing Address
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Address Line | 5100 W TAFT RD SUITE 1C
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City | LIVERPOOL
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State | NY
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Zip | 13088-3807
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Country | US
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Telephone | 315-452-2333
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Fax | 315-452-2336
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 335967
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 335967
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License Number State | NY
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