Provider Demographics
NPI:1215921283
Name:LEAHY, MARY P (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:LEAHY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3952
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-353-5600
Practice Address - Fax:845-353-5668
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-03-15
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Provider Licenses
StateLicense IDTaxonomies
NY1671161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2594362OtherGHI
0057864OtherGHI HMO
NY01852895Medicaid
132995699OtherHEALTH NOW
0D2175OtherHEALTHNET OF NORTHEAST
132995699OtherHUDSON HEALTH PLAN
20533OtherAETNA/USHC
4096837OtherAETNA
132995699OtherCIGNA PPO
23E881OtherBC/BS EMPIRE
8175389003OtherCIGNA HMO, POS
132995699OtherHORIZON HEALTHCARE OF NY
132995699OtherINDECS(ORANGE-ULSTER SCHL
132995699OtherLOCAL 1199
040426012111OtherFIDELIS (MEDICAID HMO)
132995699OtherBEECH STREET NETWORK
132995699OtherFAM HEALTH PLUS(HUDSON HP
45022POtherHIP
23E881OtherBC/BS EMPIRE
A61438Medicare UPIN