Provider Demographics
NPI:1225007271
Name:VANDO, LEONARDO (MD)
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:VANDO
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 1:507 W 145 TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031
Mailing Address - Country:US
Mailing Address - Phone:646-373-2753
Mailing Address - Fax:
Practice Address - Street 1:507 W 145TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-5101
Practice Address - Country:US
Practice Address - Phone:646-373-2753
Practice Address - Fax:212-582-0888
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00927572084P0800X, 2084P0802X
NJ25MA111480002084P0800X, 2084P0802X
NY2375862084P0802X
NY23758612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2375861OtherLICENSE
NY2375861OtherLICENSE
NY2375861OtherLICENSE
NYBV9441318OtherDEA