Basic Information
Provider Information | |||||||||
NPI: | 1720121197 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEIDERMAN | ||||||||
FirstName: | LEONARDO | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D.,ABPP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LEIDERMAN | ||||||||
OtherFirstName: | LEO | ||||||||
OtherMiddleName: | M. | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PSY.D.,ABPP | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 8 LOWER SALEM RD | ||||||||
Address2: |   | ||||||||
City: | SOUTH SALEM | ||||||||
State: | NY | ||||||||
PostalCode: | 105901215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9149255357 | ||||||||
FaxNumber: | 9149255169 | ||||||||
Practice Location | |||||||||
Address1: | 275 NORTH ST | ||||||||
Address2: |   | ||||||||
City: | HARRISON | ||||||||
State: | NY | ||||||||
PostalCode: | 105281524 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9149255357 | ||||||||
FaxNumber: | 9149255169 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/15/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 013117 | NY | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.