=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508932872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AIMEE LYNN LEO D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 01/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 DEER PARK AVENUE
-----------------------------------------------------
City | NORTH BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-242-7272
-----------------------------------------------------
Fax | 631-242-7292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 DEER PARK AVE
-----------------------------------------------------
City | NORTH BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11703-1618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-242-7272
-----------------------------------------------------
Fax | 631-242-7292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 232592
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------