Provider Demographics
NPI:1548258270
Name:LEFKOVIC, LEONARD (M D)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:LEFKOVIC
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 NEW DORP LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2359
Mailing Address - Country:US
Mailing Address - Phone:718-876-6220
Mailing Address - Fax:718-876-5969
Practice Address - Street 1:347 EDISON ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3034
Practice Address - Country:US
Practice Address - Phone:718-351-1136
Practice Address - Fax:718-667-9711
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146937207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00710283Medicaid
NY00710283Medicaid
NY68A351Medicare PIN
NYAL1525318OtherDEA