Provider Demographics
NPI:1316692866
Name:LEON SCRIMMAGER MD
Entity type:Organization
Organization Name:LEON SCRIMMAGER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIMMAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-249-1627
Mailing Address - Street 1:470 LENOX AVE APT 1P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3012
Mailing Address - Country:US
Mailing Address - Phone:212-249-1627
Mailing Address - Fax:212-249-1627
Practice Address - Street 1:470 LENOX AVE APT 1P
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3012
Practice Address - Country:US
Practice Address - Phone:212-249-1627
Practice Address - Fax:212-249-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01435161Medicaid