Provider Demographics
NPI:1598198541
Name:GAJ, LEEANNA JOY
Entity Type:Individual
Prefix:
First Name:LEEANNA
Middle Name:JOY
Last Name:GAJ
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 1:323 OAKLEY DR E
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-3315
Mailing Address - Country:US
Mailing Address - Phone:315-492-6520
Mailing Address - Fax:
Practice Address - Street 1:400 KIMBER RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1836
Practice Address - Country:US
Practice Address - Phone:315-446-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY673795163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse