Healthcare Provider Details

I. General information

NPI: 1790665461
Provider Name (Legal Business Name): IAN T LESNIAK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

726 EXCHANGE ST STE 710
BUFFALO NY
14210-1464
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-5600
  • Fax:
Mailing address:
  • Phone: 716-852-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: