Provider Demographics
NPI:1306051859
Name:MEDINA, LEIDA ADALGISA (MD)
Entity type:Individual
Prefix:DR
First Name:LEIDA
Middle Name:ADALGISA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3 SCHOOL ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2590
Mailing Address - Country:US
Mailing Address - Phone:516-676-1160
Mailing Address - Fax:516-671-5231
Practice Address - Street 1:3 SCHOOL ST
Practice Address - Street 2:SUITE 301
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2590
Practice Address - Country:US
Practice Address - Phone:516-676-1160
Practice Address - Fax:516-671-5231
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2015-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY180757-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE62806Medicare UPIN
NY62F671Medicare PIN