Provider Demographics
NPI:1669554523
Name:LESNIAK, LESNIAK J (MD)
Entity type:Individual
Prefix:DR
First Name:LESNIAK
Middle Name:J
Last Name:LESNIAK
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 1:330 RATZER RD
Mailing Address - Street 2:SUITE 18C
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7702
Mailing Address - Country:US
Mailing Address - Phone:973-694-3627
Mailing Address - Fax:973-694-3421
Practice Address - Street 1:330 RATZER RD
Practice Address - Street 2:SUITE 18C
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7702
Practice Address - Country:US
Practice Address - Phone:973-694-3627
Practice Address - Fax:973-694-3421
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA020369207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ514972Medicare ID - Type Unspecified
NJC53941Medicare UPIN