MEDICARE: LEA DAOU

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1174461164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEA DAOU

Provider Business Mailing Address
First Line	:	MOUNT SINAL MEDICAL CENTER
Second Line	:	ONE GUSTAVE L. LEVY PLACE BOX 1230
City	:	NEW YORK
State	:	NY
Zip	:	10029-6574
Country	:	US
Telephone Number	:	212-659-8838
Fax Number	:	212-996-8931

Provider Business Practice Location Address
First Line	:	MOUNT SINAL MEDICAL CENTER
Second Line	:	ONE GUSTAVE L. LEVY PLACE BOX 1230
City	:	NEW YORK
State	:	NY
Zip	:	10029-6574
Country	:	US
Telephone Number	:	212-659-8838
Fax Number	:	212-996-8931

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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