Provider Demographics
NPI:1205265014
Name:LEONFORTE, THOMAS J
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:LEONFORTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ELKHART ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1821
Mailing Address - Country:US
Mailing Address - Phone:718-967-3014
Mailing Address - Fax:
Practice Address - Street 1:115 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1001
Practice Address - Country:US
Practice Address - Phone:212-766-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-03
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist