Leo, Raphael Jerome

Leo, Raphael Jerome is an individual health care provider with primary practice located at 462 Grider St , Buffalo NY 14215-3021. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Leo, Raphael Jerome can be contacted via phone (716) 898-4857.

Contact Information

Primary practice address
462 Grider St Buffalo NY 14215-3021
Phone: (716) 898-4857
Fax: (716) 898-3986
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 185977 New York

Profile Details

NPI number 1063488062
LBN Legal business name Leo, Raphael Jerome
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063488062 NPPES
New York MEDICAID 01604737

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