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General NPI Number Information
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NPI Number | 1750622239
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Entity Type | Organization
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Legal Business Name | DUNN-LEA MEDICAL PC
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Dates
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Enumeration Date | 03/08/2013
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 3096 51ST ST
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City | WOODSIDE
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State | NY
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Zip | 11377-1457
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Country | US
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Telephone | 718-204-1469
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Fax | 718-545-1726
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Provider Business Mailing Address
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Address Line | 440 E 20TH ST 9B
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City | NEW YORK
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State | NY
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Zip | 10009-8208
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Country | US
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Telephone | 718-204-1469
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Fax | 718-545-1726
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. GLORIA J DUNNDER LEACOCK
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Credential |
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Telephone | 718-204-1469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 204175
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License Number State | NY
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