Basic Information
| Provider Information | |||||||||
| NPI: | 1215921283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEAHY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459873952 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 CROSFIELD AVE | ||||||||
| Address2: | SUITE 318 | ||||||||
| City: | WEST NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109942226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453535600 | ||||||||
| FaxNumber: | 8453535668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 03/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 1671161 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2594362 | 01 | GHI | OTHER | 0057864 | 01 | GHI HMO | OTHER | 01852895 | 05 | NY | MEDICAID | 132995699 | 01 | HEALTH NOW | OTHER | 0D2175 | 01 | HEALTHNET OF NORTHEAST | OTHER | 132995699 | 01 | HUDSON HEALTH PLAN | OTHER | 20533 | 01 | AETNA/USHC | OTHER | 4096837 | 01 | AETNA | OTHER | 132995699 | 01 | CIGNA PPO | OTHER | 23E881 | 01 | BC/BS EMPIRE | OTHER | 8175389003 | 01 | CIGNA HMO, POS | OTHER | 132995699 | 01 | HORIZON HEALTHCARE OF NY | OTHER | 132995699 | 01 | INDECS(ORANGE-ULSTER SCHL | OTHER | 132995699 | 01 | LOCAL 1199 | OTHER | 040426012111 | 01 | FIDELIS (MEDICAID HMO) | OTHER | 132995699 | 01 | BEECH STREET NETWORK | OTHER | 132995699 | 01 | FAM HEALTH PLUS(HUDSON HP | OTHER | 45022P | 01 | HIP | OTHER |