Mario Leon, Physician Assistant
Physician Assistant in Brooklyn, NY. Individual provider (NPI-1).
NPI number1508074170
StatusActive
Last updated in NPPESFeb 4, 2019
Details
- NPI
- 1508074170
- Entity type
- Individual (NPI-1)
- Name
- Mario Leon
- Credential
- Physician Assistant
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 18, 2007
- Last updated
- Feb 4, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 011824-1 | NY | Yes |
Practice location
800 Poly PlBrooklyn, NY 11209-7104
Phone 718-836-6630
Mailing address
6787 Exeter StForest Hills, NY 11375-4150
Phone 347-257-0575
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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