Individual provider Active NPI

Caroline Leung, PA-C, RD

  • Physician Assistant
  • Corona, NY
National Provider Identifier
1073945390
Registry record updated Mar 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
023295 Issued in NY
Practice address
3716 108TH St
Corona, NY 11368-2025
Phone
(718) 651-4000
NPI assigned
Aug 9, 2013
Last updated
Mar 12, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 023295 NY Primary
Registered Dietitian 133V00000X 1065954 NY

Addresses

Primary practice location

3716 108TH St
Corona, NY 11368-2025

Mailing address

1065 Southern Blvd
Bronx, NY 10459-2417
Phone (718) 589-2440

Other practice location 1

1065 Southern Blvd
Bronx, NY 10459-2417
Phone (718) 589-2440

Other practice location 2

14732 Jamaica Ave
Jamaica, NY 11435-4042
Phone (718) 443-1767

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200917002074 NY Practitioner - Registered Dietitian Or Nutrition Professional 4587082813 Reassigns benefits to 1 organization
I20221107002075 NY Practitioner - Physician Assistant 4587082813 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1065954NYMDRegistered Dietitian
023295NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Caroline Leung Nutrition LLC Dietitian, Registered Current Accepting new patients
Urban Health Plan, Inc. CurrentSince Jul 1, 2022 Accepting new patients
Urban Health Plan, Inc. CurrentSince Jul 1, 2022 Accepting new patients
Sun River Health Inc Current Accepting new patients
Sun River Health Inc. CurrentSince May 14, 2020 Accepting new patients
Trustees of Columbia University in the City of New York Physician Assistant CurrentSince Feb 15, 2024 Accepting new patients
Urban Health Plan, Inc. Current Accepting new patients

Locations

3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006

1065 Southern Blvd
Bronx, NY 10459
Phone 71858924404222

1515 Southern Blvd
#H
Bronx, NY 10460
Phone (718) 589-1600

3716 108th St
Corona, NY 11368
Phone (718) 651-4000

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

161 Fort Washington Ave
Fl 8
New York, NY 10032
Phone (212) 342-1155

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: ckl9003@direct.nyp.org
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 8

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

NPI Registry JSON

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

{
    "created_epoch": "1376006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552348800000",
    "number": "1073945390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104592417",
            "telephone_number": "718-589-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 108TH ST",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682025",
            "telephone_number": "718-651-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1065 Southern Blvd",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104592417",
            "country_code": "US",
            "telephone_number": "718-589-2440",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14732 Jamaica Ave",
            "address_purpose": "LOCATION",
            "city": "Jamaica",
            "state": "NY",
            "postal_code": "114354042",
            "country_code": "US",
            "telephone_number": "718-443-1767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEUNG",
        "first_name": "CAROLINE",
        "name_prefix": "Ms.",
        "credential": "PA-C, RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-09",
        "last_updated": "2019-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "023295",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "1065954",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, NY

Sources for this page

Verify at the official NPI Registry.