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General NPI Number Information
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NPI Number | 1376809343
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Entity Type | Individual
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Provider Name | LEAH I ELIZONDO
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Gender | Female
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 420 E 70TH ST APT 9G
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City | NEW YORK
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State | NY
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Zip | 10021-5320
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Country | US
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Telephone | 917-226-8808
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E. 70TH ST, APT 9G
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City | NEW YORK
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State | NY
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Zip | 10021-5320
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Country | US
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Telephone |
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | S0664
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License Number State | TX
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