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General NPI Number Information
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NPI Number | 1508454752
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Entity Type | Individual
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Provider Name | DOROTHY LEO
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Gender | Female
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 21111 NORTHERN BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361-3241
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Country | US
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Telephone | 212-273-6272
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Fax |
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Provider Business Mailing Address
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Address Line | 626 VILLAGE GRN N
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-4717
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Country | US
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Telephone | 516-205-3990
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 340306
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License Number State | NY
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