Provider Demographics
NPI:1669512448
Name:MENTEL, LESLIE STEPHEN (LAC)
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:STEPHEN
Last Name:MENTEL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1454
Mailing Address - Country:US
Mailing Address - Phone:585-317-6725
Mailing Address - Fax:
Practice Address - Street 1:7700 PITTSFORD PALMYRA RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9590
Practice Address - Country:US
Practice Address - Phone:585-317-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001964-1171100000X
MA212673171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist