Provider Demographics
NPI:1376894378
Name:LESNIAK, AGNIESZKA (APN)
Entity Type:Individual
Prefix:MRS
First Name:AGNIESZKA
Middle Name:
Last Name:LESNIAK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4147
Mailing Address - Country:US
Mailing Address - Phone:908-587-9300
Mailing Address - Fax:
Practice Address - Street 1:240 WILLIAMSON ST STE 402
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3673
Practice Address - Country:US
Practice Address - Phone:908-354-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00393000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0357120Medicaid
NJ267089Q4TMedicare PIN