Provider Demographics
NPI:1528059219
Name:LEON, IRAIS (MD)
Entity type:Individual
Prefix:
First Name:IRAIS
Middle Name:
Last Name:LEON
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 1:346 GRAND AVE
Mailing Address - Street 2:UNITED MEDICAL ASSOCIATES PC
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2558
Mailing Address - Country:US
Mailing Address - Phone:607-770-0025
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:33-57 HARRISON ST
Practice Address - Street 2:UNITED MEDICAL ASSOCIATES PC
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2143
Practice Address - Country:US
Practice Address - Phone:607-770-0025
Practice Address - Fax:607-729-3982
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD208521207R00000X
NY2109421207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01832035Medicaid
NY01832035Medicaid
G74283Medicare UPIN
NYBB1373Medicare ID - Type Unspecified