Basic Information
Provider Information | |||||||||
NPI: | 1104182583 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HANKE | ||||||||
FirstName: | LEIGH | ||||||||
MiddleName: | FLAGLER | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 37 E 67STREET | ||||||||
Address2: | APT 2A | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100654952 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2123058592 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 260 LONG RIDGE RD | ||||||||
Address2: |   | ||||||||
City: | STAMFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 069021627 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2037852579 | ||||||||
FaxNumber: | 2037376319 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/10/2012 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 208100000X | 283722 | NY | Y |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   |
No ID Information.