MEDICARE: MARY P LEAHY MD

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	1671161	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2594362	OTHER	GHI
2	0057864	OTHER	GHI HMO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	132995699	OTHER	HEALTH NOW
5	0D2175	OTHER	HEALTHNET OF NORTHEAST
6	132995699	OTHER	HUDSON HEALTH PLAN
7	20533	OTHER	AETNA/USHC
8	4096837	OTHER	AETNA
9	132995699	OTHER	CIGNA PPO
10	23E881	OTHER	BC/BS EMPIRE
11	8175389003	OTHER	CIGNA HMO, POS
12	132995699	OTHER	HORIZON HEALTHCARE OF NY
13	132995699	OTHER	INDECS(ORANGE-ULSTER SCHL
14	132995699	OTHER	LOCAL 1199
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	132995699	OTHER	BEECH STREET NETWORK
17	132995699	OTHER	FAM HEALTH PLUS(HUDSON HP
18	45022P	OTHER	HIP

General Provider Information

NPI Number	:	1215921283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY P LEAHY MD

Provider Business Mailing Address
First Line	:	20 GRAND ST
Second Line	:	3RD FLOOR
City	:	WARWICK
State	:	NY
Zip	:	10990-1035
Country	:	US
Telephone Number	:	845-987-3952
Fax Number	:	845-987-5979

Provider Business Practice Location Address
First Line	:	2 CROSFIELD AVE
Second Line	:	SUITE 318
City	:	WEST NYACK
State	:	NY
Zip	:	10994-2226
Country	:	US
Telephone Number	:	845-353-5600
Fax Number	:	845-353-5668

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	03/15/2011

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Directions to “ MARY P LEAHY MD” Practice Location

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