Provider Demographics
NPI:1093177222
Name:STORK-BINYAMIN, LEAH BERNICE (MD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:BERNICE
Last Name:STORK-BINYAMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CLUB CT
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1002
Mailing Address - Country:US
Mailing Address - Phone:206-372-1194
Mailing Address - Fax:
Practice Address - Street 1:30 CLUB CT
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1002
Practice Address - Country:US
Practice Address - Phone:206-372-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-26
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY302970207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program