Healthcare Provider Details

I. General information

NPI: 1477538205
Provider Name (Legal Business Name): THOMAS HENRY LESNIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 LAFAYETTE ST
NORWICH CT
06360-2708
US

IV. Provider business mailing address

119 LAFAYETTE ST
NORWICH CT
06360-2708
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-1947
  • Fax: 860-823-1644
Mailing address:
  • Phone: 860-886-1947
  • Fax: 860-823-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number016431
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: