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General NPI Number Information
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NPI Number | 1386220671
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Entity Type | Organization
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Legal Business Name | LEIGH ETTINGER, MD, PLLC
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Dates
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Enumeration Date | 03/18/2021
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 153 MAIN ST STE 203
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City | NEW PALTZ
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State | NY
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Zip | 12561-1116
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Country | US
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Telephone | 845-475-8116
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Fax |
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Provider Business Mailing Address
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Address Line | 153 MAIN ST STE 203
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City | NEW PALTZ
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State | NY
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Zip | 12561-1116
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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 | OWNER
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Name | LEIGH ETTINGER
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Credential | MD
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Telephone | 917-838-5457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080B0002X
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Taxonomy Name | Pediatric Obesity Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number |
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License Number State |
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