Provider Demographics
NPI:1487709317
Name:LESHNER, MARK HAROLD (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:HAROLD
Last Name:LESHNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RIVERDALE CHIROPRACTIC OFFICE
Mailing Address - Street 2:PO BOX 1285
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:718-796-7878
Mailing Address - Fax:718-796-7878
Practice Address - Street 1:3424 KINGSVRIDGE AVENUE
Practice Address - Street 2:SUITE 1H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-796-7878
Practice Address - Fax:718-796-7878
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0031181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X05Y41OtherBC BS
X05Y41OtherBC BS
XCWZP1Medicare ID - Type UnspecifiedGRP #