Provider Demographics
NPI:1487255220
Name:GARCIA DE LEON, NELCY M
Entity type:Individual
Prefix:
First Name:NELCY
Middle Name:M
Last Name:GARCIA DE LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 THAMSEN DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1054
Mailing Address - Country:US
Mailing Address - Phone:845-461-0425
Mailing Address - Fax:
Practice Address - Street 1:11 THAMSEN DR
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-1054
Practice Address - Country:US
Practice Address - Phone:845-461-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator