Provider Demographics
NPI:1316067424
Name:LEON, JARED ADAM (DC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:ADAM
Last Name:LEON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:213 HALLOCK RD
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3000
Mailing Address - Country:US
Mailing Address - Phone:631-689-1000
Mailing Address - Fax:631-444-0885
Practice Address - Street 1:213 HALLOCK RD
Practice Address - Street 2:SUITE 4B
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3000
Practice Address - Country:US
Practice Address - Phone:631-689-1000
Practice Address - Fax:631-444-0885
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2013-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYX010577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161656487OtherUNITED HEALTHCARE
NY5C4995OtherLANDMARK
NY837174OtherMPN
NY656214OtherACN
NYP3175055OtherOXFORD
NYAA72409OtherMDNY
NY3354694OtherAETNA
NYJL0X6G0320OtherBLUE CROSS BLUE SHEILD
NYC10577-7OtherWORKER'S COMPENSATION
NYAA72409OtherMDNY
NYU98315Medicare UPIN