Provider Demographics
NPI:1447502240
Name:RYAN, LESLIE (MSED)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WOODLAWN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9473
Mailing Address - Country:US
Mailing Address - Phone:631-228-4565
Mailing Address - Fax:
Practice Address - Street 1:27 WOODLAWN RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9473
Practice Address - Country:US
Practice Address - Phone:631-228-4565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist