Provider Demographics
NPI:1528066446
Name:LEON, STUART B (DPM)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:B
Last Name:LEON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8475 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1624
Mailing Address - Country:US
Mailing Address - Phone:718-657-8921
Mailing Address - Fax:718-657-9650
Practice Address - Street 1:8475 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1624
Practice Address - Country:US
Practice Address - Phone:718-657-8921
Practice Address - Fax:718-657-9650
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005513213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03899KOtherMEDICARE-GHI
NYPB076K9021OtherEMPIRE-MEDICARE
NY02387740Medicaid
NY02387740Medicaid