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General NPI Number Information
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NPI Number | 1790853745
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Entity Type | Individual
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Provider Name | KIM MARIE LEIDNER MSRD, CDE
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 986 SUNRISE HWY
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City | WEST BABYLON
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State | NY
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Zip | 11704-6111
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Country | US
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Telephone | 631-587-6060
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Fax | 631-587-1364
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Provider Business Mailing Address
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Address Line | 34 STRATFORD AVE
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City | GREENLAWN
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State | NY
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Zip | 11740-2519
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Country | US
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Telephone | 631-368-3706
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Fax | 631-368-1027
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 806597
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License Number State | IL
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