Provider Demographics
NPI:1235502576
Name:HAWRONIAK, LESIA
Entity Type:Individual
Prefix:
First Name:LESIA
Middle Name:
Last Name:HAWRONIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-2815
Mailing Address - Country:US
Mailing Address - Phone:201-681-9807
Mailing Address - Fax:
Practice Address - Street 1:113 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2815
Practice Address - Country:US
Practice Address - Phone:201-681-9807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00246900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist