Individual provider Active NPI

Marylen Leon

  • Family Nurse Practitioner
  • East Hampton, NY
National Provider Identifier
1053087619
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F346034 Issued in NY
Practice address
470 Pantigo Rd
East Hampton, NY 11937-2648
Phone
(631) 702-0212
NPI assigned
Aug 23, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F346034 NY Primary

Addresses

Primary practice location

470 Pantigo Rd
East Hampton, NY 11937-2648

Mailing address

PO Box 2206
Sag Harbor, NY 11963-0111
Phone (631) 702-0212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210917000968 NY Practitioner - Nurse Practitioner 2668879669 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Lij Urgent Care PCGroup PAC ID 6002131778, 389 clinicians

Practice addresses (Care Compare)

1 Miller PL
Smithtown, NY 11787-3629
Phone (631) 604-4024

Hospital & facility affiliations

  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F346034NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Meeting House Lane Medical Practice PC CurrentSince Sep 13, 2021 Accepting new patients
Medical Office of Doctor Ilona K Polak PC CurrentSince Jun 1, 2025 Accepting new patients

Locations

470 Pantigo Rd
East Hampton, NY 11937
Phone (631) 329-5900

34 Bay St
#103
Sag Harbor, NY 11963
Phone (631) 537-1892

57 Hampton Rd
Ste 201
Southampton, NY 11968
Phone (631) 283-1126

325 Meeting House Ln
Ste 403
Southampton, NY 11968
Phone (631) 283-2100

Interoperability endpoints

  • Direct secure messaging: marylen.leon.p1@direct.shproviders.nextgenshare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1053087619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2206",
            "city": "SAG HARBOR",
            "state": "NY",
            "postal_code": "119630111",
            "telephone_number": "631-702-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 PANTIGO RD",
            "city": "EAST HAMPTON",
            "state": "NY",
            "postal_code": "119372648",
            "telephone_number": "631-702-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEON",
        "first_name": "MARYLEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F346034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Hampton, NY

Sources for this page

Verify at the official NPI Registry.