Healthcare Provider Details

I. General information

NPI: 1528063492
Provider Name (Legal Business Name): LESLIE A HUSZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 10TH CT
VERO BEACH FL
32960-6559
US

IV. Provider business mailing address

7390 45TH ST
VERO BEACH FL
32967-7708
US

V. Phone/Fax

Practice location:
  • Phone: 772-299-8422
  • Fax: 772-365-0861
Mailing address:
  • Phone: 772-299-8422
  • Fax: 772-365-0861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberME0057023
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME0057023
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: