Healthcare Provider Details

I. General information

NPI: 1124028147
Provider Name (Legal Business Name): HANNA LESICKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANNA SOSNOWSKA M.D.

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 12/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 CALYER ST
BROOKLYN NY
11222-2702
US

IV. Provider business mailing address

120 97TH ST
BROOKLYN NY
11209-7602
US

V. Phone/Fax

Practice location:
  • Phone: 718-349-2442
  • Fax: 718-349-2243
Mailing address:
  • Phone: 718-491-4414
  • Fax: 718-492-9758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number221781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: