Leonid Bilenkin, PHYSICIAN ASSISTANT
Individual provider Active NPI Surgical Physician Assistant · Greenwich, CT
NPI 1083780795 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1083780795
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- 002258 (CT)
- Practice address
- 55 Holly Hill LN
110
Greenwich, CT 06830-6074 - Phone
- (203) 863-4670
- Fax
- (203) 863-4674
- NPI assigned
- Nov 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002258 | CT | MD | Clinical Psychologist |
| 003739 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Yale University | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 003739 | NY | |
| Surgical Physician Assistant | 363AS0400X | 002258 | CT | Yes |
Addresses
Primary practice location
55 Holly Hill LN
110
Greenwich, CT 06830-6074
Mailing address
16 Glen Drive
South Salem, NY 10590
Phone (914) 533-1182
Other practice location 1
1543 Inwood Ave
Bronx, NY 10452-2001
Phone (855) 681-8700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002258 | Other | CT | CONNECTICUT STATE PHYSICIAN ASSISTANT LICENSE |
| 003739-1 | Other | NY | NY STATE PHYSICIAN ASSISTANT LICENSE |
Other providers in Greenwich, CT
- Bestfit DME, Inc.
- Bestfit DME, Inc.
- Better Hearing at Home
- Carlye Marissa Bianco
- Mina Bibeault
- Yaryna Bilinska
- Anna Marie Birchenough
- Cheryl S Birnbaum
- Julianne Rebecca Biroschak
- Colleen Bisaccio
All providers in Greenwich, CT · Surgical Physician Assistant in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.