Active NPI
Kim Marie Leidner, MSRD, CDE
- Registered Dietitian
- West Babylon, NY
National Provider Identifier
1790853745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 806597
- Practice address
- 986 Sunrise Hwy
West Babylon, NY 11704-6111 - Phone
- (631) 587-6060
- Fax
- (631) 587-1364
- NPI assigned
- Nov 30, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 806597 | IL | Primary |
Addresses
Primary practice location
986 Sunrise Hwy
West Babylon, NY 11704-6111
Mailing address
34 Stratford Ave
Greenlawn, NY 11740-2519
Phone (631) 368-3706
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5457751 | Other | NY | CIGNA |
| AZ00894 | Other | NY | MDNY |
| 3C7122 | Other | NY | HEALTHNET |
| 8099804 | Other | NY | GHI |
| 2595970 | Other | NY | AETNA |
| IG0951 | Other | NY | BLUE CROSS |
| P2720854 | Other | NY | OXFORD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090702000279 | NY | Practitioner - Registered Dietitian Or Nutrition Professional | 4082765045 | Practice locations: Lindenhurst, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 806597 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790853745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 STRATFORD AVE",
"city": "GREENLAWN",
"state": "NY",
"postal_code": "117402519",
"telephone_number": "631-368-3706",
"fax_number": "631-368-1027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "986 SUNRISE HWY",
"city": "WEST BABYLON",
"state": "NY",
"postal_code": "117046111",
"telephone_number": "631-587-6060",
"fax_number": "631-587-1364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEIDNER",
"first_name": "KIM",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "MSRD, CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "806597",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "5457751",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MDNY",
"identifier": "AZ00894",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "3C7122",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "8099804",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2595970",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "IG0951",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P2720854",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Babylon, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.