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General NPI Number Information
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NPI Number | 1487797304
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Entity Type | Individual
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Provider Name | SCOTT JOSEPH LEOGRANDE ATC
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 49 LILAC RD
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City | WESTHAMPTON BEACH
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State | NY
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Zip | 11978-2008
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Country | US
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Telephone | 631-288-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 7 JERUSALEM HOLLOW RD
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City | MANORVILLE
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State | NY
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Zip | 11949-3121
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Country | US
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Telephone | 631-874-2578
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 5560828
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License Number State | NY
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