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Individual

COREY MARK LEIDENFROST

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MA

Contact information

Practice address
620 TRONOLONE PL, NIAGARA FALLS, NY 14301-1910
(716) 205-0825
(716) 205-0824
Mailing address
525 WASHINGTON ST, BUFFALO, NY 14203-1711
(716) 856-4494
(716) 842-1277

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00030241501
UNIVERA
NY
01
000506354005
COMMUNITY BLUE
NY
Enumeration date
01/12/2007
Last updated
07/08/2007
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