MEDICARE: LEADING EDGE MEDICAL DIAGNOSTIC MD PC

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1467761957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEADING EDGE MEDICAL DIAGNOSTIC MD PC

Provider Business Mailing Address
First Line	:	290 BROADWAY STE 1
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-5301
Country	:	US
Telephone Number	:	845-562-4545
Fax Number	:	845-562-4555

Provider Business Practice Location Address
First Line	:	290 BROADWAY
Second Line	:	STE 1
City	:	NEWBURGH
State	:	NY
Zip	:	12550-5301
Country	:	US
Telephone Number	:	845-562-4545
Fax Number	:	845-562-4545

Authorized Official
Title or Position	:	MANAGER
Name	:	GENE KHODAK
Credential	:
Telephone Number	:	845-562-4545

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	06/01/2021

Similar Medicare Providers

1982541793 — ANDY MEJIA
Practice Location Address:

377 BROADWAY
NEWBURGH, NY
12550-5301

Practice Phone: 845-505-7242
Practice Fax:

1255370821 — MARY COLLEEN MORETTO PT
Practice Location Address:

333 BROADWAY
NEWBURGH, NY
12550-5301

Practice Phone: 845-562-1054
Practice Fax: 845-562-6148

1376750471 — ANDRES JOAQUIN GRECO MD
Practice Location Address:

377 BROADWAY
NEWBURGH, NY
12550-5301

Practice Phone: 845-562-2291
Practice Fax:

1386893998 — THERALINK OF NEW YORK INC.
Practice Location Address:

377 BROADWAY
NEWBURGH, NY
12550-5301

Practice Phone: 845-562-1790
Practice Fax: 845-562-1790

1669192712 — NEW WINDSOR FAMILY CARE LLC
Practice Location Address:

377 BROADWAY
NEWBURGH, NY
12550-5301

Practice Phone: 845-562-2191
Practice Fax:

1255277802 — MR. JAMES THORPE III CASAC-T
Practice Location Address:

172 LIBERTY ST
NEWBURGH, NY
12550-4912

Practice Phone: 845-561-5783
Practice Fax: 845-393-8012

Directions to “LEADING EDGE MEDICAL DIAGNOSTIC MD PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.