Individual
LEACROFT GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1545 ATLANTIC AVE, BROOKLYN, NY 11213-1122
(800) 376-5566
Mailing address
PO BOX 29889, NEW YORK, NY 10087-9889
(800) 376-5566
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
195521
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01677572
—
NY
Enumeration date
08/08/2006
Last updated
07/08/2007
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