Individual
GLORIA DUNNDER LEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3096 51ST ST, WOODSIDE, NY 11377-1457
(718) 204-1469
(718) 545-1726
Mailing address
440 E 20TH ST, APT 9B, NEW YORK, NY 10009-8213
(212) 545-2400
(646) 312-0481
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
204175
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00695941
—
NY
Enumeration date
11/16/2006
Last updated
06/24/2016
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