Provider Demographics
NPI:1073989265
Name:LESHANSKY, MERYL (PA)
Entity type:Individual
Prefix:
First Name:MERYL
Middle Name:
Last Name:LESHANSKY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MERYL
Other - Middle Name:
Other - Last Name:WILLIAMSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 KNIGHTSBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-5211
Mailing Address - Country:US
Mailing Address - Phone:732-824-3356
Mailing Address - Fax:
Practice Address - Street 1:210 KNIGHTSBRIDGE LN
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-5211
Practice Address - Country:US
Practice Address - Phone:732-824-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018920363A00000X
PAMA059526363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty