Provider Demographics
NPI:1023173747
Name:FORMAN, LEANNE MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:MICHELLE
Last Name:FORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:93 INNINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546-1130
Mailing Address - Country:US
Mailing Address - Phone:914-941-9307
Mailing Address - Fax:
Practice Address - Street 1:WESTCHESTER MEDICAL CENTER, GRASSLANDS ROAD
Practice Address - Street 2:CEDARWOOD HALL OCCUPATIONAL HEALTH
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-5140
Practice Address - Fax:914-493-7359
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY192473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01837916Medicaid
NY01837916Medicaid
NY30N1905271Medicare PIN