Provider Demographics
NPI:1659350601
Name:LECKBAND, GARWOOD EMERSON (MD)
Entity Type:Individual
Prefix:
First Name:GARWOOD
Middle Name:EMERSON
Last Name:LECKBAND
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 1:5320 MILITARY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2149
Mailing Address - Country:US
Mailing Address - Phone:716-297-1686
Mailing Address - Fax:716-297-1706
Practice Address - Street 1:5320 MILITARY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2149
Practice Address - Country:US
Practice Address - Phone:716-297-1686
Practice Address - Fax:716-297-1706
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090865207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2111703OtherINDEPENDENT HEALTH
NY00026277202OtherUNIVERA
NY000497468004OtherCOMMUNITY BLUE
NY00144376Medicaid
NY000497468004OtherCOMMUNITY BLUE
NY00144376Medicaid