Provider Demographics
NPI:1487720280
Name:LEO, SALVATORE A (MD)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:A
Last Name:LEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1618
Mailing Address - Country:US
Mailing Address - Phone:631-242-7272
Mailing Address - Fax:631-242-7292
Practice Address - Street 1:1400 DEER PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703
Practice Address - Country:US
Practice Address - Phone:631-242-7272
Practice Address - Fax:631-242-7292
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35182207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY69122FW551OtherMEDICARE ID
NY69122FW551OtherMEDICARE ID