Provider Demographics
NPI:1578534731
Name:GERMAIN, LESLY (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLY
Middle Name:
Last Name:GERMAIN
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 1:76 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1329
Mailing Address - Country:US
Mailing Address - Phone:585-786-3503
Mailing Address - Fax:585-786-3505
Practice Address - Street 1:76 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1329
Practice Address - Country:US
Practice Address - Phone:585-786-3503
Practice Address - Fax:585-786-3505
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208844207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01665576Medicaid
NYG31244Medicare UPIN
NYRB2752Medicare PIN