Provider Information for 1568931293
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LEON LANSING DICKINSON
Sex: Male
NPI: 1568931293
Last Updated: 2018-11-26
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1568931293 | ||||||||
| Enumeration Date | 2018-11-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 919 BOYD ST WATERTOWN, NY 13601-3522 United States Phone: 315-788-2835 | Fax: | ||||||||
| Primary Practice Address | 482 BLACK RIVER PKWY WATERTOWN, NY 13601-2416 United States Phone: 315-782-1777 | Fax:315-785-8628 | ||||||||
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