Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 199121 | NY |
NPI | 1003986217 |
---|---|
Provider Name | John M Leo |
First Address | Bronx, NY 10465-1726 |
Second Address | New Rochelle, NY 10801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |