Provider Demographics
NPI:1902920457
Name:LEONARDI, GREGG V (ABOC)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:V
Last Name:LEONARDI
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6929
Mailing Address - Country:US
Mailing Address - Phone:631-427-8500
Mailing Address - Fax:631-421-1225
Practice Address - Street 1:281 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6929
Practice Address - Country:US
Practice Address - Phone:631-427-8500
Practice Address - Fax:631-421-1225
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007008156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician