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NPI Code Detail

MEDICARE: SAGE NICOLE LEAX

MEDICARE: SAGE NICOLE LEAX
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1548199243
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAGE NICOLE LEAX
Provider Business Mailing Address
First Line : 5 DORCHESTER DR
Second Line :
City : CORAM
State : NY
Zip : 11727-2310
Country : US
Telephone Number : 631-444-0101
Fax Number : 631-444-0102
Provider Business Practice Location Address
First Line : 1413 STONY BROOK RD
Second Line :
City : STONY BROOK
State : NY
Zip : 11790-2214
Country : US
Telephone Number : 631-444-0101
Fax Number : 631-444-0102
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2026
Last Update Date : 05/18/2026

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Directions to “ SAGE NICOLE LEAX ” 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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