Provider Demographics
NPI:1124028147
Name:LESICKA, HANNA (MD)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:LESICKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:
Other - Last Name:SOSNOWSKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:120 97TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7602
Mailing Address - Country:US
Mailing Address - Phone:718-491-4414
Mailing Address - Fax:718-492-9758
Practice Address - Street 1:217 CALYER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2702
Practice Address - Country:US
Practice Address - Phone:718-349-2442
Practice Address - Fax:718-349-2243
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221781208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02174321Medicaid
NY02174321Medicaid
NYH44206Medicare UPIN