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NPI Code Detail

MEDICARE: LESLIE PARK

MEDICARE: LESLIE PARK
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
1152W00000XOptometrist009878NY

General Provider Information

NPI Number : 1538841812
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE PARK
Provider Business Mailing Address
First Line : 24047 69TH AVE
Second Line :
City : DOUGLASTON
State : NY
Zip : 11362-1943
Country : US
Telephone Number : 646-472-9816
Fax Number :
Provider Business Practice Location Address
First Line : 1258 6TH AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10020-1511
Country : US
Telephone Number : 646-789-4843
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2023
Last Update Date : 08/04/2023

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Directions to “ LESLIE PARK ” Practice Location

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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.

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