Provider Demographics
NPI:1053726893
Name:ELBAUM, LEAH M
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:ELBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:M
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14 GILMAN TER
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6058
Mailing Address - Country:US
Mailing Address - Phone:917-912-7360
Mailing Address - Fax:
Practice Address - Street 1:14 GILMAN TER
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-6058
Practice Address - Country:US
Practice Address - Phone:917-912-7360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY705604132174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist