MEDICARE: DR. LESLIE AUQUILLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	29043101	NY
2	207R00000X	Internal Medicine Physician	MD22781	ME
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1063822468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE AUQUILLA M.D.

Provider Business Mailing Address
First Line	:	3462 9TH ST APT 1
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-5166
Country	:	US
Telephone Number	:	718-709-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3462 9TH ST APT 1
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-5166
Country	:	US
Telephone Number	:	718-709-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	01/10/2022

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