Provider Demographics
NPI:1982690079
Name:LESIC, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LESIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ASSEMBLY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-9602
Mailing Address - Country:US
Mailing Address - Phone:585-624-4520
Mailing Address - Fax:585-624-4829
Practice Address - Street 1:30 ASSEMBLY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MENDON
Practice Address - State:NY
Practice Address - Zip Code:14506-9602
Practice Address - Country:US
Practice Address - Phone:585-624-4520
Practice Address - Fax:585-624-4829
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-232069208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics