Provider Demographics
NPI:1114218823
Name:LEITMAN, ELLEN
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:LEITMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 E 76TH ST APT 7C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2432
Mailing Address - Country:US
Mailing Address - Phone:917-837-3796
Mailing Address - Fax:
Practice Address - Street 1:363 E 76TH ST APT 7C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2432
Practice Address - Country:US
Practice Address - Phone:917-837-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered