Provider Demographics
NPI:1447269584
Name:BRUSIE, LESLIE JEAN (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JEAN
Last Name:BRUSIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 ROUTE 376
Mailing Address - Street 2:SUITE 16
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590
Mailing Address - Country:US
Mailing Address - Phone:845-223-8080
Mailing Address - Fax:845-223-8081
Practice Address - Street 1:942 ROUTE 376
Practice Address - Street 2:SUITE 16
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590
Practice Address - Country:US
Practice Address - Phone:845-223-8080
Practice Address - Fax:845-223-8081
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2028021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01775337Medicaid
1976257OtherUNITED
2028021OtherLICENSE
33D0991911OtherCLIA
4C1525OtherPHCS
00V731OtherBCBS
10031841OtherCDPHP
53035OtherGHI HMO
P2526879OtherOXFORD
141833509OtherTAX ID
2191726OtherAETNA
4C1525OtherHEALTHNET
1783916003OtherCIGNA
191724OtherWELLCARE
5998555OtherGHI PPO
O87164OtherMVP
O87164OtherMVP
NY00V931Medicare PIN
G58062Medicare UPIN