Individual
DR. LEO JAN BASTIAENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1620 ROUTE 22 STE 203, BREWSTER, NY 10509-4052
(845) 278-2500
(844) 454-5096
Mailing address
366 HERITAGE HLS UNIT A, SOMERS, NY 10589-4048
(412) 334-3393
(844) 454-5096
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
171146
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06049783
—
NY
Enumeration date
10/10/2005
Last updated
04/06/2022
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