Provider Demographics
NPI:1528171907
Name:URCUYO, LEONEL (MD)
Entity type:Individual
Prefix:
First Name:LEONEL
Middle Name:
Last Name:URCUYO
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 1:201 E 66TH ST
Mailing Address - Street 2:SUITE 18K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6451
Mailing Address - Country:US
Mailing Address - Phone:212-734-4220
Mailing Address - Fax:212-327-0267
Practice Address - Street 1:201 E 66TH ST
Practice Address - Street 2:SUITE 18K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-6451
Practice Address - Country:US
Practice Address - Phone:212-734-4220
Practice Address - Fax:212-327-0267
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY21A-91Medicare ID - Type Unspecified
NYB11020Medicare UPIN