Basic Information
| Provider Information | |||||||||
| NPI: | 1437641776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACHADO | ||||||||
| FirstName: | LEIGH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | TEACHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 AUSTIN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187627633 | ||||||||
| FaxNumber: | 7188868694 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 LONGWOOD RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLE ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119532045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312816800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2018 | ||||||||
| LastUpdateDate: | 07/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | NY | N | Other Service Providers | Health Educator | 174400000X | 1437641776 | NY | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 174H00000Y | 01 | NY | HEALTH EDUCATOR | OTHER |