Provider Demographics
NPI:1831268523
Name:PARKER, LESLIE J (CSNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:PARKER
Suffix:
Gender:F
Credentials:CSNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3105
Mailing Address - Country:US
Mailing Address - Phone:631-751-2892
Mailing Address - Fax:
Practice Address - Street 1:1212 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3105
Practice Address - Country:US
Practice Address - Phone:631-751-2892
Practice Address - Fax:631-751-4148
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203396163W00000X
NYF4000881363L00000X
NY265410363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S46737Medicare UPIN
91V901Medicare ID - Type Unspecified