Provider Demographics
NPI:1033478045
Name:KUSHNER, LESLIE S (CNM)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:S
Last Name:KUSHNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-8916
Mailing Address - Country:US
Mailing Address - Phone:845-354-9300
Mailing Address - Fax:
Practice Address - Street 1:54 S STATE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3445
Practice Address - Country:US
Practice Address - Phone:440-352-0608
Practice Address - Fax:440-352-0640
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13031-NM367A00000X
NY001945176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife