Provider Demographics
NPI:1528638780
Name:TRUONG-LEISNER, CHI TU (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHI
Middle Name:TU
Last Name:TRUONG-LEISNER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-1030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:619 FULTON AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4553
Practice Address - Country:US
Practice Address - Phone:516-571-1300
Practice Address - Fax:516-572-1741
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2024-05-21
Deactivation Date:2022-06-06
Deactivation Code:
Reactivation Date:2022-07-15
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY403977363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program