Provider Demographics
NPI:1063524353
Name:EMMA, LEONARD J (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:J
Last Name:EMMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141284
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:914-305-4633
Mailing Address - Fax:914-305-5587
Practice Address - Street 1:1775 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:914-305-4633
Practice Address - Fax:914-305-5587
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158738207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00979075Medicaid
NY00979075Medicaid
NY39D591Medicare PIN