Provider Demographics
NPI:1790068989
Name:WEHMEYER, LESLIE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:WEHMEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CROSSWAYS PARK DR W
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2002
Mailing Address - Country:US
Mailing Address - Phone:516-536-2800
Mailing Address - Fax:
Practice Address - Street 1:45 CROSSWAYS PARK DR W
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2037
Practice Address - Country:US
Practice Address - Phone:516-992-4568
Practice Address - Fax:516-992-4637
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00258200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical