Individual
MRS. KIM MARIE LEIDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSRD, CDE
Contact information
Practice address
986 SUNRISE HWY, WEST BABYLON, NY 11704-6111
(631) 587-6060
(631) 587-1364
Mailing address
34 STRATFORD AVE, GREENLAWN, NY 11740-2519
(631) 368-3706
(631) 368-1027
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
806597
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2595970
AETNA
NY
01
—
3C7122
HEALTHNET
NY
01
—
5457751
CIGNA
NY
01
—
8099804
GHI
NY
01
—
AZ00894
MDNY
NY
01
—
IG0951
BLUE CROSS
NY
01
—
P2720854
OXFORD
NY
Enumeration date
11/30/2006
Last updated
07/08/2007
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