Provider Demographics
NPI:1982018388
Name:LESZAK, PAULA (NP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:LESZAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SPRUCE STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH COLLINS
Mailing Address - State:NY
Mailing Address - Zip Code:14111-0458
Mailing Address - Country:US
Mailing Address - Phone:716-337-3706
Mailing Address - Fax:
Practice Address - Street 1:2101 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:NORTH COLLINS
Practice Address - State:NY
Practice Address - Zip Code:14111
Practice Address - Country:US
Practice Address - Phone:716-337-3706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402175-1363LP0808X
NYF306898-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3944878Medicaid
NY01465154Medicaid