Basic Information
| Provider Information | |||||||||
| NPI: | 1982102141 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LEISER | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 154 ANSTICE ST | ||||||||
| Address2: | |||||||||
| City: | OYSTER BAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117713534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163615295 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27005 76TH AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110401402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184707000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2018 | ||||||||
| LastUpdateDate: | 01/23/2018 | ||||||||
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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 | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.