Provider Demographics
NPI:1396144382
Name:DELEONARDIS, JESSE RYAN (CT)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:RYAN
Last Name:DELEONARDIS
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 WELLWOOD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-1677
Mailing Address - Country:US
Mailing Address - Phone:631-225-2623
Mailing Address - Fax:631-991-3386
Practice Address - Street 1:672 WELLWOOD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1677
Practice Address - Country:US
Practice Address - Phone:631-225-2623
Practice Address - Fax:631-991-3386
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist