Basic Information
| Provider Information | |||||||||
| NPI: | 1447279708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE LEON | ||||||||
| FirstName: | AUREA ANDREA | ||||||||
| MiddleName: | TANCUNGCO | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 WEST 4TH STREET | ||||||||
| Address2: | MOUNT VERNON NEIGHBORHOOD HEALTH CENTER | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146997200 | ||||||||
| FaxNumber: | 9146990837 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 WEST 4TH STREET | ||||||||
| Address2: | MOUNT VERNON NEIGHBORHOOD HEALTH CENTER | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146997200 | ||||||||
| FaxNumber: | 9146990837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 02/22/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 224575 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 224575 | 01 | NY | LICENSE # | OTHER | BD5666853 | 01 | NY | DEA # | OTHER |