Provider Demographics
NPI:1093732067
Name:LESHINSKI, RUSSELL THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:THOMAS
Last Name:LESHINSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 N SUSQUEHANNA TRL STE 170A
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-8975
Mailing Address - Country:US
Mailing Address - Phone:570-452-9098
Mailing Address - Fax:
Practice Address - Street 1:1372 N SUSQUEHANNA TRL STE 170A
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-8975
Practice Address - Country:US
Practice Address - Phone:570-452-9098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051191363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232809429006OtherTRICARE
PA50019935OtherBLUE CROSS
PAP00194075OtherRAILROAD MEDICARE
PAP00194075OtherRAILROAD MEDICARE
PA232809429006OtherTRICARE