Individual
LEONID BILENKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
55 HOLLY HILL LN, 110, GREENWICH, CT 06830-6074
(203) 863-4670
(203) 863-4674
Mailing address
16 GLEN DRIVE, SOUTH SALEM, NY 10590
(914) 533-1182
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
003739
NY
363AS0400X
Surgical Physician Assistant
Primary
002258
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002258
CONNECTICUT STATE PHYSICIAN ASSISTANT LICENSE
CT
01
—
003739-1
NY STATE PHYSICIAN ASSISTANT LICENSE
NY
Enumeration date
11/27/2006
Last updated
03/17/2018
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