Basic Information
| Provider Information | |||||||||
| NPI: | 1538150057 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEIKIN | ||||||||
| FirstName: | ENID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106012214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143288444 | ||||||||
| FaxNumber: | 9143288414 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106012214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143288444 | ||||||||
| FaxNumber: | 9143288414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 147239 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01074895 | 05 | NY | MEDICAID |