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General NPI Number Information
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NPI Number | 1316550882
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Entity Type | Individual
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Provider Name | BREDA MARIA LEAHY O.D
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Gender | Female
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | BREDA LEAHY 44 LAKESIDE DR
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City | NORTH SALEM
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State | NY
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Zip | 10560
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Country | US
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Telephone | 908-432-0296
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Fax |
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Provider Business Mailing Address
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Address Line | BREDA LEAHY 44 LAKESIDE DR
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City | NORTH SALEM
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State | NY
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Zip | 10560
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Country | US
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Telephone | 908-432-0296
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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 | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 006157
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License Number State | NY
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