Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 251544-1 | NY |
N | 207N00000X | Dermatologist | OT011311 | PA |
NPI | 1003084138 |
---|---|
Provider Name | Angela Marie Leo |
First Address | Brooklyn, NY 11214-2817 |
Second Address | Brooklyn, NY 11214-2817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2008 |
Last Update Date | 22/01/2010 |