Provider Demographics
NPI:1124082011
Name:LEUNG, BLANCHE (MD)
Entity type:Individual
Prefix:DR
First Name:BLANCHE
Middle Name:
Last Name:LEUNG
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 1:70 BOWERY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4607
Mailing Address - Country:US
Mailing Address - Phone:212-343-8390
Mailing Address - Fax:212-343-8328
Practice Address - Street 1:70 BOWERY
Practice Address - Street 2:SUITE 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4607
Practice Address - Country:US
Practice Address - Phone:212-343-8390
Practice Address - Fax:212-343-8328
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02470079Medicaid
NY50C052Medicare ID - Type Unspecified650 FIRST AVE. OFFICE
NY02470079Medicaid
NY50C051Medicare ID - Type Unspecified254 CANAL ST. OFFICE