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NPI Code Detail

MEDICARE: MARC ANTHONY DI LEO PMHNP

MEDICARE: MARC ANTHONY DI LEO PMHNP
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
12084P0800XPsychiatry PhysicianF407860-01NY

General Provider Information

NPI Number : 1164373528
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARC ANTHONY DI LEO PMHNP
Provider Business Mailing Address
First Line : 37 NORTHERN BLVD UNIT 45
Second Line :
City : GREENVALE
State : NY
Zip : 11548-4002
Country : US
Telephone Number : 516-621-1374
Fax Number :
Provider Business Practice Location Address
First Line : 770 E 176TH ST
Second Line :
City : BRONX
State : NY
Zip : 10460-4617
Country : US
Telephone Number : 718-466-8034
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2026
Last Update Date : 02/03/2026

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