Provider Demographics
NPI:1487091922
Name:LEBAN, MARY E (APN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:LEBAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 YORK AVENUE, 4TH FLOOR
Mailing Address - Street 2:WEILL CORNELL MEDICAL CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:646-962-4800
Mailing Address - Fax:646-962-0377
Practice Address - Street 1:1305 YORK AVENUE, 4TH FLOOR
Practice Address - Street 2:WEILL CORNELL MEDICAL CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:646-962-4800
Practice Address - Fax:646-962-0377
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR10787100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily