Provider Demographics
NPI:1477538205
Name:LESNIK, THOMAS HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HENRY
Last Name:LESNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2708
Mailing Address - Country:US
Mailing Address - Phone:860-886-1947
Mailing Address - Fax:860-823-1644
Practice Address - Street 1:119 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2708
Practice Address - Country:US
Practice Address - Phone:860-886-1947
Practice Address - Fax:860-823-1644
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016431207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT502758OtherAETNA
030800OtherHEALTHNET
CO010016431CT01OtherANTHEM BC/BS
030800OtherHEALTHNET
CTB39313Medicare UPIN