Provider Demographics
NPI:1508898867
Name:LESITSKY, NEIL (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:LESITSKY
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:2588 STATE ROUTE 903
Practice Address - Street 2:STE 2
Practice Address - City:ALBRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18210
Practice Address - Country:US
Practice Address - Phone:570-722-2125
Practice Address - Fax:570-722-2127
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038870E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA70233OtherGEISINGER
PA545141OtherBCBS
PA40261OtherAETNA
PA5900102OtherGHI NEW YORK INS
PA569210OtherAETNA
PA700001986OtherRR MEDICARE
PA0012165430001Medicaid
PA2694337OtherOXFORD
PA70233OtherGEISINGER
PA700001986OtherRR MEDICARE