Individual provider Active NPI

Aurea Andrea Tancungco De Leon, M.D

  • Pediatrics Physician
  • Mount Vernon, NY
National Provider Identifier
1447279708
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
224575 Issued in NY
Practice address
107 West 4TH Street
Mount Vernon Neighborhood Health Center
Mount Vernon, NY 10550
Phone
(914) 699-7200
Fax
(914) 699-0837
NPI assigned
Jul 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 224575 NY Primary

Addresses

Primary practice location

107 West 4TH Street
Mount Vernon Neighborhood Health Center
Mount Vernon, NY 10550

Mailing address

107 West 4TH Street
Mount Vernon Neighborhood Health Center
Mount Vernon, NY 10550
Phone (914) 699-7200

Other identifiers 1

IdentifierTypeStateIssuer
224575OtherNYLICENSE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
224575NYMDPediatrics Physician

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1447279708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 WEST 4TH STREET",
            "address_2": "MOUNT VERNON NEIGHBORHOOD HEALTH CENTER",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "10550",
            "telephone_number": "914-699-7200",
            "fax_number": "914-699-0837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 WEST 4TH STREET",
            "address_2": "MOUNT VERNON NEIGHBORHOOD HEALTH CENTER",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "10550",
            "telephone_number": "914-699-7200",
            "fax_number": "914-699-0837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LEON",
        "first_name": "AUREA ANDREA",
        "middle_name": "TANCUNGCO",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "224575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "224575",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.