Active NPI
Mario Leon, PHYSICIAN ASSISTANT
- Physician Assistant
- Brooklyn, NY
National Provider Identifier
1508074170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 011824-1
- Practice address
- 800 Poly PL
Brooklyn, NY 11209-7104 - Phone
- (718) 836-6630
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 011824-1 | NY | Primary |
Addresses
Primary practice location
800 Poly PL
Brooklyn, NY 11209-7104
Mailing address
6787 Exeter St
Forest Hills, NY 11375-4150
Phone (347) 257-0575
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
| License | State | Type | Specialty |
|---|---|---|---|
| 011824 | NY | MD | Mental Health Counselor |
| 011824-1 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549238400000",
"number": "1508074170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6787 EXETER ST",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113754150",
"telephone_number": "347-257-0575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 POLY PL",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112097104",
"telephone_number": "718-836-6630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEON",
"first_name": "MARIO",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2019-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "011824-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.