Healthcare Provider Details

I. General information

NPI: 1376894378
Provider Name (Legal Business Name): AGNIESZKA LESNIAK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLIAMSON ST STE 402
ELIZABETH NJ
07202-3673
US

IV. Provider business mailing address

520 N WOOD AVE
LINDEN NJ
07036-4147
US

V. Phone/Fax

Practice location:
  • Phone: 908-354-8900
  • Fax:
Mailing address:
  • Phone: 908-587-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00393000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: