MEDICARE: BLANDY LEONARD

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	283X00000X	Rehabilitation Hospital	033950	NY

General Provider Information

NPI Number	:	1073897005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANDY LEONARD

Provider Business Mailing Address
First Line	:	1048 E 84TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4228
Country	:	US
Telephone Number	:	770-825-6454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1048 E 84TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4228
Country	:	US
Telephone Number	:	770-825-6454
Fax Number	:

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

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	10/10/2011

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Directions to “ BLANDY LEONARD ” Practice Location

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