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General NPI Number Information
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NPI Number | 1720886807
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Entity Type | Organization
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Legal Business Name | BIG LEAP MEDICAL GROUP OF AMERICA P.A.
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 169 MADISON AVE STE 2828
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City | NEW YORK
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State | NY
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Zip | 10016-5101
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Country | US
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Telephone | 786-305-4192
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Fax |
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Provider Business Mailing Address
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Address Line | 169 MADISON AVE STE 2828
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City | NEW YORK
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State | NY
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Zip | 10016-5101
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Country | US
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Telephone | 929-205-6638
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Fax | 212-901-0943
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Authorized Official
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Title or Position | OWNER
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Name | SUMEET VADERA
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Credential |
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Telephone | 786-305-4192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology 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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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